Need help: HUGE back pain while on 2 mg Ativan (lorazepam)

Is this tolerance or interdose withdrawal? Or does not matter. What can I do? Prescribed for anxiety.  Been on diazepam 4 months, switched to lorazepam a month ago. Took 3 mg for 7-10 days maybe. Now on 2mg a day (1mg in the middle of the night, for sleep, 1mg during day). In the afternoon I have HUGE back pain, I am doubled down on the floor for maybe an hour at a time. It passes with or without lorazepam. Just suffer? Anyone got this so bad? Should I try and cross over to diazepam, as per Prof. Ashton? Please help...

Hello Teologul,

I'm sorry to hear you're struggling with back pain. It sounds like what you are experiencing may be related to withdrawal.

 

Are you familiar with the half-lives of the benzo and z-drugs you're on/you've been on? This pharmacokenetic variable is probably one of the most important features of these drugs, and in my experience heavily dictates what will happen symptomatically while switching between drugs in this class of medications and during withdrawal. I'll give you some details about how I think this applies in your situation.

 

Four months on diazepam up to 20mg/day is long enough to develop physical dependence to this dosage range. But more importantly, diazepam builds it's potency over many doses as it has a staggeringly long half-life of 36–200 hours. So this means each dose adds to the previous for up to a week or two, sometimes longer. The same applies when taking a reduction; the diazepam doses are still at some significant potency floating around in the body a week or more after taking them, as well as any doses taken more recently.

 

The point of this detail about diazepam is that, as I understand it, when you were switched to lorazepam you were still on essentially your full dose of diazepam and adding 3mg of lorazepam on top of that. Because lorazepam is so short-acting and potent this is somewhere around a cumulative benzo dosage equivalency of 50mg of diazepam, according to Ashton. Because of this when you switched to 2mg of lorazepam 7-10 days later, you weren't just taking a 33% reduction in a critical-dose medicine, you were also starting to realize the reduction of 20mg of diazepam which likely took this long to start significantly being eliminated from your body. I suspect you were actually starting to feel a 60% reduction (the 20mg diazepam plus 1mg of lorazepam, even though your 3mg lorazepam dosage looks like it was techincally an updose from the diazepam).

 

My take away from what you describe is that your nervous system is doing really well considering this radical change in dosage. I don't know why doctors are switching people from diazepam to lorazepam, but it seems to only make tapering more difficult and comes with the complicated spike in blood serum level of benzodiazepines that I describe earlier. Furthermore it appears doctors commonly updose a patient onto their new benzo during a sudden crossover, as though this is some magic trick to eliminate withdrawal issues; in your case this created a somewhat staggering updose as the lorazepam combined with the diazepam in your blood was likely more than double your previous benzo dosage equivalency.

 

Without knowing more about your situation, yes, I suspect you could benefit from a return to diazepam if you tolerated it well and since it comes in low-potency tablet sizes (and a liquid in the US and perhaps other places) that are very convenient for tapering. Also the long half-life can make tapering simple, in many cases requiring only tablet splitting and 2-week hold periods between reductions.

 

Regarding your back pain, it sounds like you're doing the perfect thing; lying down, paying attention, waiting it out. I suspect your are experiencing more nervous system dysfunction lately and you may be responding to life stresses in a more severe way than usual; this can look like many things but pain is definitely one of them. I was actually suffering severe back pain myself last week from overworking myself and I had to spend a while on the floor unable to situp, and then keep coming back to the bed throughout the following days to recover; moving and especially lifting anything was very painful. I am feeling fully recovered now, but more cautious.

 

Lastly, I just want to mention that zolpidem (Ambien) has been very problematic for other taperers. Even the slow release Ambien CR has a half-life of 2-6 hours; this can be extremely inconvenient for tapering from what I've heard and since it acts on the brain in the same way as benzos, can cause essentially the same withdrawal symptoms, and I expect exacerbate interdose withdrawal. I suspect that this combination of a short-acting benzo lorazepam and a very short-acting z-drug Ambien CR is worse both as a treatment and for tapering than what you had going with diazepam.

 

I hope this helps. Let us know if you'd like help planning a gradual step-wise crossover to diazepam, or any other tapering approach that could work for you. 

I would like a crossover to diazepam, please. I am taking 1 mg lorazepam in the morning @7am, and 1mg in the afternoon, maybe 3pm. At bedtime Ambien CR and Mirtazapine 30mg. Also a hydroxyzine 25 mg in the middle of the night. As mentioned I sleep maybe 5 hrs, wake up with huge anxiety. The back pain is better after moving the Ativan from 1 AM at night to 3 PM. That make sense , I guess.

BUT I AM NOT STABLE, can't function much, on medical leave from work. Should I wait? How long? Because I'm suffering.

I really appreciate this.

Anybody out there? I can't take it anymore. I think I am in tolerance. Very agitated. Help. Please. Now.

Hello Teologul,

I'm sorry to hear that you're unstable and suffering. Let's get the worst news over with first: suffering is unavoidable at this point. Life has suffering, and benzo dosing, especially rapid prescription adjustments, can really increase that suffering temporarily. I suspect there will be ongoing challenges in functionality before this is over, and you may need time, weeks or months, to get your feet back under you. I think there is a huge, personal-to-you, silver-lining, but I just want to warn you up front that there is no quick cure to quick "cures" like the ones you've been prescribed; slow and steady is how I've found my way out of neurological instability and I encourage you to consider the same as the most viable way forward.

 

The really good news is I think you can take steps today to start feeling better.

 

First, unless you were feeling intolerant to the lorazepam, I suggest returning to a dosage of 3mg/day of lorazepam and holding at this dosage until you stabilize; a dosing schedule roughly 8-hours apart I think would be ideal (ex. 5am, 1pm, 9pm).

 

Stabilizing after what you've been through may take a week or two, but because of lorazepam's potency and the size of this updose, you should begin to feel improvements very quickly. I do not recommend attempting a crossover to diazepam from a short-acting benzo without first stabilizing; the results will only be further dysfunction and suffering.

 

Once you're noticing that you are stabilizing on a larger daily dose of lorazepam, I suggest getting a reliable prescription of diazepam from your doctor. This will likely involve at least a phone call, maybe an appointment (virtual is maybe an option). You can ask for a sudden crossover which is what they'd likely prescribe, but if you have lorazepam tablets left over at that point we can help you plan a step-wise crossover at-home and this step-wise method will likely dramatically reduce your suffering as the diazepam builds up in your system again. The size of your prescribed diazepam dosage is going to be very important! Since you're stabilizing on 3mg of lorazepam, I suggest a diazepam dosage of 30mg. I think if you explain you needed to return to 3mg of lorazepam, your doctor may understand that 20mg of diazepam isn't going to cut it at this time.

 

This is Dr. Ashton's slow taper schedule for a 3mg/day dosage of lorazepam.

https://www.benzoinfo.com/ashtonmanual/chapter2b/#schedule8

 

If you want to involve your doctor, you can show them this taper schedule; it justifies the 30mg diazepam script, and explains a formulaic rate of reduction. Formulaic tapers have a low rate of success, but it's a good model for considering how you could crossover and what tapering might look like. I do NOT recommend following this example tapering schedule to the letter; I suggest symptom-based tapering. Here are some recommendations in the form of a pamphlet made to help inform prescribers...

https://benzoreform.org/wp-content/uploads/2020/11/Pamphlet-3-BZRA-Discontinuation-1-Getting-Started-v1.2.pdf

 

If you can stabilize on lorazepam at 3mg/day, you may want to drop the zolpidem script; even the CR has such a short half-life that I think you're basically going cold-turkey on it every single day. It may be helping you sleep a little more right now, but once sleep improves I suggest looking for an opportunity to drop it as I think it's a very problematic drug, especially for benzo taperers.

 

The hydroxyzine and mirtazapine seem to be well tolerated by many taperers, but may have limited effectiveness against the benzo withdrawal symptoms.

 

I hope this message has helped you to set realistic expectations, see a path or paths forward that you can use to make progress on improving your condition today, and a landscape ahead of you that will take some time to navigate but could include a successful crossover to diazepam once you are stable.

 

Let me know if you have questions or if there's other ways we can help.

You're my ray of light...

I was under the impression that I should taper the mirtazapine first (as the last introduced drug and the most stimulating-as I am at 30 mg- actually I cut a quarter of the 15 pill, that's 3.75mg, so I take 26.75mg now). Somehow I feel better in the afternoon after cutting mirtazapine a bit. Still have HUGE backpain twice a day, usually before dozing Ativan. Better in the pm. This pain was not an initial presentation of my anxiety.

My present psych doc wants to add sertraline. Since I reacted good to that years ago. This episode, after sertraline initiation 4 months ago, I had a spike in anxiety and insomnia. That's how I ended up on 15-30-45 mirt.

 

But here is my whole long story:

A few prior episodes of anxiety, solved with Effexor, Diazepam, Ambien and psychotherapy (CBT included), in the last 15 years.

Last April I was diagnosed with a neck mass. Anxiety increased, used Lunesta3  and Diazepam (5-10mg) prior to surgery.  The tumor was benign. Thanks God! But my anxiety continued...Started Zoloft 25 beginning on May , with resultant spike in anxiety and insomnia. Lunesta switched to Ambien CR. The doc recommended Mirtazapine. I got up to 45, no relief, but side effects(urinary problems, near sight bad). Cut mirt to 30 over a month, still almost there for 4 weeks. I got Risperidone 0.5mg for a week or too; got scared of possible side effects and quit that.  Used hydroxyzine 25mg a few time, can't see a benefit.

After being sleepy on 20 mg diazepam, the doc switched me to lorazepam. But I was using one doze in the middle of the night and only one to cover the whole daytime. As such, I started having this bad back pain. Now I am dozing Ativan twice (1mg each) 7 am and 2 pm. Still huge back pain prior to dosing and through the day. Evenings are a bit better. Maybe because I am taking 1 mg Ativan to 2 pm?

Since cutting mirt a bit, to 26.25 mg, the afternoons and evening are a bit clearer. Again, maybe because of Ativan in the afternoon...

I am scared to start sertraline on top of 30 Mirt, as my doctor wants. I want to taper something. But I am not functional on 2 mg Ativan. Your idea might be not so bad, to stabilize on 3mg Ativan and taper the Mirtazapine. And don't touch anything else.

 

Thank you from  the bottom of my heart.

 

Hi Teologul,

I saw you started two new tapering threads looking for advice.

 

I appreciate you sharing more details about your situation. You pose some questions that can only be answered by trial and error, and some concerns, such as about the sertraline, which I have opinions about but are always your decisions to make.

 

Some people use antidepressants during tapering, sometimes to their benefit, sometimes to their discomfort. Either way, I believe antidepressants are a delay-tactic for underlying issues; a delay which, like benzos, can be extremely difficult to withdraw from.

 

My suggestion was to leave things as they are and to updose to stabilize on 3mg of lorazepam. Once stable, I would suggest considering a step-wise crossover to an Ashton equivalent of diazepam, and once stable on a full crossover, to taper the diazepam at whatever rate is manageable for you by using a slow, symptom-based, patient-led taper.

 

I can't advise on your use of mirtazapine or hydroxyzine, but from what I've read about other users experiences on this forum, I don't imagine these substances causing you serious harm at this time and I think you will know better than me about how to adjust their dosage to your benefit. The largest challenge that I see before you is the z-drug and benzo prescriptions, and specifically the short active duration of both these medications.

 

Yes, I agree with the idea to split up your lorazepam doses over the day. I hope you can leave atleast an 8-hour window at night between doses for sleep, but dividing your lorazepam across the rest of the day may be necessary to stabilize. 3-4 doses seems average from what I've read about lorazepam, but 5-6 doses may be necessary in some cases. Creating a stable blood serum level is something I consider highly important in my own tapering experiences, and especially while recovering from instability.

 

Lastly, from your brief medical history, I gather that these drugs are being offered to you as solutions to anxiety. It is my understanding that there is a well-established body of evidence that these drugs are not solutions for anxiety beyond 2-4 weeks. Furthermore, I have a suspicion that there are not actually any medications in existence that reliably and safely reduce anxiety, depression, or other psychological issues over the long-term.

 

Because of the apparent inefficacy of medications, I suggest extending your skill-building efforts beyond CBT and exploring therapies that can support you in naturally and skillfully reducing your anxiety without medications. Possible avenues to explore include trauma-informed psychotherapy, meditation, breath-work, visualizations, art, nature-exposure, and many many more.

 

Lastly, it's been my experience that fear, anxiety, grief, pain, and all forms of suffering in life arise despite my best efforts. These are not, in my opinion, a deficiency in medication nor a failing of human character or composition; I believe suffering is an intelligent reflection of our perceptions of the world, sometimes through mental lenses formed before we could even form memories. I am learning to accept and explore my suffering, and to use it as a tool to uncover more about myself. I believe this kind of growth is possible for all of us, and necessary to thrive despite the inevitable challenges we face as humans.

 

I hope this helps.

I am not kidding. You are a huge help.

But I am very reluctant to go back to 3 mg lorazepam, it's like giving up after all that suffering...My wife is worried that I'll up my dose to 3mg, in 2-3 weeks to 4...5.

What would you do? Touch nothing, but the lorazepam? Stay as it is with the mirtazapine and zolpidem? What's the end game ? CBT? I tried that for years, with variable success. I know SSRI is not the answer, but all I want NOW is a respite and to be able to function again. Should I spilt my 3mg in 6 equal doses? I finally got rid of the disabling back pain by dosing both mgs during the daytime and for the first time in 5 months I was dreaming. It is my understanding that this is a good sign, once REM sleep returns, correct?

Slownsteady,

 

I appreciate your concern and advice. And I agree that more chemicals are not the long time  answer to my problem. But I find myself in this predicament now. I do have to do SOMETHING.

I was told you should taper first the excitatory drug and later the downer. As such, maybe I should taper mirtazapine first? Should I take 0.5mg x 6 of lorazepam? Would that keep my levels more even? Or 1 mg in the evening and 2 mg spread over the day (0.5 x 4)? What if I don't stabilize at 3mg?

I am not taking the hydroxyzine anymore. My doc is advising sertraline on top of my 30 mirtazapine. I am a bit worried about that, adding a new chemical. Also the possibility of serotonin syndrome.

I have tried meditation. It's true, for 5 minutes only . I have no patience and that doesn't help. The last few days were really tough and waiting for your messages kept me going.

I really appreciate what you're doing.

Desperately,

Me

I'm sorry to hear how desperate you're feeling. I cannot reply as often or as thoroughly as I would like, but I will try.

 

I understand your reluctance to return to 3mg/day. Unfortunately, you're down a rabbit-hole being switched rapidly from a long acting benzo to this short acting one. I suggest that the name of the game right now be neurological stability.

 

Yes, updosing is NOT a long-term strategy and I do not recommend taking additional updoses to the one I am suggesting. However, in my experience updosing can be imperative in regaining the cognitive abilities we need to self-advocate with doctors and make better tapering decisions going forward. Unless your wife has benzo tapering experience and knows more about your dosing difficulties than we do, I suspect that her fears are ungrounded.

 

I've been saying this to a few people today, here it is again: I believe we are first and foremost gaining understanding, and successful tapering is just a benefit of that understanding. By this I am suggesting not to measure your progress by the dosage numbers, but by how skillful you are becoming at maintaining your neurological stability. If you can maintain or regain that neurological stability while tapering, then this is what I consider successful tapering; if you cannot, then I suggest focusing on gaining a better understanding of what is going on so that you can begin to achieve these results. In my experience, the taper itself can be secondary, maybe even tertiary, to the goal of understanding ourselves and these drugs so as to maintain functionality.

 

I think impatience is a withdrawal symptom, and something that's worth monitoring during this whole process. Unchecked, I've seen that impatience can lead to reckless reductions, ignoring the need for stability, and generally failing health and functionality.

 

Yes, I would consider dosing at least 3-4 times a day, or 5-6 if you are so inclined. I like the idea of dosing 5x/day because it's easy to divide 16 hours awake into a dose every 4 hours. 5 doses might seem excessive, but you could start to consolidate them down to 3 after you stabilize. Again, I suggest leaving at least 8 hours of time between doses at night for sleep.

 

Here's an example dosing schedule for 3mg:

6am - 0.5mg

10am - 0.5mg

2pm - 0.5mg

6pm - 0.5mg

10pm - 1mg

 

I suggest once you're more stable, or if you don't think you need such a wide dosage spread to consolidate your doses to something like:

6am - 1mg

2pm - 1mg

10pm - 1mg

 

This is consolidation to 3x/day is for the purpose of then using Ashton's slow taper guide for 3mg lorazepam, and beginning with a step-wise crossover to an equivalent dose of diazepam as she describes in the link I sent earlier.

 

I don't know what if any drugs you're on that are excitatory, so your comment about tapering these first confuses me. I heard that trialing a new AD can cause anxiety, but I thought mirtazapine typically helped people sleep as well as being an anti-histamine. Not "good" in my book, but not all bad either.

 

Yes, I would be concerned about the sertraline script as well, especially while you are unstable.

 

You're in the driver's seat Teologul. You call the shots, and you get the feedback. I hope my suggestions help you navigate your circumstances. I'm sorry I cannot speak more directly to your other medications, but I am confident in my opinions about stabilizing on benzos.

I am forever grateful. So, you think 0.5 mg per dose is enough, if dosed more often? Or try 3 x 1mg? And don't touch the Ambien CR and Mirtazapine (or even go back to 30mg Mirt I was on for a month?)

I think the mirtazapine is kind of exciting over 15 mg, that's what I have heard. As of now, I am at only 2 mg Ativan ( 1mg x 2) and cutting the mirtazapine for 4-5 day. I am the worst I have ever been. It looks like ground gained on paper, but it doesn't feel like that. I am seeing a new doc tomorrow, I am afraid she will recommend new drugs! All AD are anxiety-producing in the beginning, so I am very scared and unstable. D

Please, please keep in touch.

My suggested schedules were both for 3mg/day; just in-case you missed it, on the 5x/day schedule I was suggesting 0.5mg for four doses and then 1mg at bed time, since you'd be going 8 hours before your next dose.

 

I think if you updosed on the lorazepam you could quit the Ambien CR as soon as you were stable. I do not trust zolpidem to cause anything but problems for taperers.

 

I wouldn't go by what you've heard about these drugs, but I realize it's difficult to judge the effects when you are on so many at once. If taking less mirtazapine leaves you feeling better then tapering that makes sense; however, it sounds like tapering it hasn't been helping so I'd suggest leaving it alone.

 

Many of us have updosed. I've had to updose twice, and I did not regret it either time. There's the "live to fight another day" mentality, and that's worked for me. My highest priority: functionality and well-being; secondary goal: tapering progress.

 

Lorazepam works pretty quickly IME. I don't think it's too late to improve your symptoms with an updose before your appointment. I updosed and held for a day before going to the ER after a failed 25% reduction over 2 weeks; I'm confident I only left the ER because I'd made the updose and waited 24 hours. Otherwise I doubt I would have presented my situation as clearly and calmly as I needed in-order to leave without inpatient, horrible food, and more drugs.

 

I suggest postponing trialing any new drugs until you can stabilize on your benzo. I also suggest not messing with your current non-benzo drug doses, again, until you can stabilize on your benzo. These are just my suggestions.

 

I'm sorry I can't do more for you Teologul. Please keep us posted. 

So take my 3rd Ativan in the evening and skip the Ambien now, or after some stabilization? Take the Ativan and Ambien in the evening with Mirtazapine 30mg?

My suggestion is to quit the Ambien after some stabilization on the lorazepam.

My suggestion is to take 3mg/day lorazepam divided into at least 3 doses per day to stabilize.

My suggestion is to leave your mirtazapine dose wherever it is.

 

These are just suggestions. I hope this is more clear. 

I cut mirtazapine 4-5 days ago, from 30 to 26.25mg. Should I go back to 30 then. Any difference between taking 0.5mg lorazepam  5 or 6 times, versus 3 times 1mg of lorazepam?

I cut mirtazapine 4-5 days ago, from 30 to 26.25mg. Should I go back to 30 then.

I don't know. I suggest leaving it alone for now.

 

Any difference between taking 0.5mg lorazepam  5 or 6 times, versus 3 times 1mg of lorazepam?

Maybe. That's why I gave you a 5x/day dosage schedule to consider. It may help you stabilize to dose more frequently. But it's more work and ultimately I would suggest consolidating to 3x/day, especially if you plan to use Ashton's crossover schedules.

 

Maybe a first step is just 3mg/day divided into 3x/day, and see if that makes enough of a difference before making your life more complicated with 5 doses per day. Just something to  consider.

 

I think these are all decision you will have to make for yourself, ideally with the help of a medical provider.

What stabilization means? I was not stable for months now? Can function during the day?

Switched to Clonazepam 0.5 in the am, 1 mg in the pm; no more Ambien CR. Added Lexapro 5 mg for now. Is this a good idea?

Sleep was awful, woke up at 3 am, instead of usual 5:30.

Switched to Clonazepam 0.5 in the am, 1 mg in the pm; no more Ambien CR. Added Lexapro 5 mg for now. Is this a good idea?

Sleep was awful, woke up at 3 am, instead of usual 5:30.

 

This sounds like a big improvement. I can't speak to the Lexapro, but I think the other medication changes are going to make things much easier for stabilizing and tapering benzos.

 

Your doctor may not have mentioned that clonazepam takes about 5-9 days to reach full potency due to it's ~35 hour half-life. Switching from lorazepam and zolpidem to clonazepam suddenly seems to me like it would cause at least a few days of increased withdrawal symptom severity.

 

But you also took that updose! 1.5mg clonazepam (once up to full strength) ~= 3mg lorazepam (according to Ashton equivalents). I wouldn't be surprised if it was only a few more days before you're noticing significant improvements; I expect the first day or two of this sudden crossover to be the worst.

 

Hang in there friend. I'm glad to hear you made a decision with your care provider, and when you're ready (stable, functional, etc), we're here to help you plan the rest of your taper if you'd like that support. 

Thank you for your encouragement. I feel a bit more stable, but "weird". The doctor agreed to reintroduce Ambien CR, if I get no good sleep for couple days...But she said she doesn't like the mix of benzos with non-benzos hypnotics. I am scared of ALL medication, but can't function NOW without it. Should I tough it out and get rid of the Ambien CR, if possible?

Took the clonazepam at 9pm and fell asleep soon. Maybe that's why I woke up at 2:30AM.

Thank you for your continuous support. God bless!

In my observations, Ambien is problematic for taperers. I suggest going 5-9 days on your clonazepam dose to see what it is doing for you by itself; I think you will continue to see improvements beyond this period in terms of sleep and other functions. The hard part, it sounds like, is making it long enough for the clonazepam to get up to strength and to start to stabilize. I suggest not taking any addition medications during this time.

 

Of course this is all up to you and your medical provider.

 

In my opinion, it's okay to have sleep problems for a while. I didn't think I was going to survive at one point my sleep was so terrible (1-2 hours per night, with nightmares), but I got better with time and care. I've found that waking up very early is a good time to practice calming techniques to find something that works; the basics are things like practicing apathy and surrender, self-awareness, positive self-talk, etc.

 

You can do this. 

My 1 mg Clonazepam gave me only 90 minutes sleep last night. So I took my Ambien CR  around 1:30AM...slept until 6. I cannot live on 2 hrs sleep. I cannot practice apathy, I am getting panicky when waking up.

The introduction of Lexapro gave my some additional anxiety. My Clonazepam is not covering me very well, during night or day.

What now?

Unless I have the dates wrong, I think you're still on day two or three of your sudden crossover to a longer-acting benzo. This adjustment is commonly uncomfortable and takes time. This is why gradual, step-wise crossovers to longer-acting benzos are recommended, and sudden crossovers can be so problematic.

 

I'm sorry you're struggling, but I don't think the clonazepam will fill in for the lorazepam until you've had more time taking regular doses. In the meantime, it's no surprise things have gotten worse. This is why I suggested taking the updose and stabilizing on the lorazepam before crossing to a longer acting drug; in my opinion that would have been a much more comfortable adjustment. For now, if you can stay the course I am confident that you will keep seeing improvements.

 

IME neurological stability is a fragile thing with benzos, and doctors (and their patients) often don't realize this fragility until it's too late. You can still live and learn like the rest of us! Healing happens.

 

I'll be praying for you. 

My 0.75 Clonazepam is doing nothing at night: I still need the Ambien. My 0.75 in the morning is doing nothing; again I am not covered. Yesterday during day I was not so bad...But today I woke up with huge anxiety.

My doc agreed to 1mg and 1 mg, maybe that's going to help. But I am so scared...how I am going to get rid of it? I hope the time will come when I will have to taper it...

Thanks and God bless!

Thank you, slownsteady.

So I should stick with the program. Maybe in a week (I am day 5) the clonazepam will reach steady-state? I slept 12 hr last night , with 1 mg clonazepam, mirtazapine and Ambien. But my days are not covered. BY midafternoon, my agitation is through the roof. I suspect starting Lexapro is contributing to that. I really appreciate your advise. Unfortunately, my Doc is very aggressive on meds. She think 0.5 clonazepam will compensate for my Ambien CR! Nobody is touching my Ambien for now! I cannot sleep without it. I imagine it will be the last to taper. For now, I am fighting with the Lexapro initiation. I am taking it in the morning.

Thank you.