Lorazepam to Diazepam cross-over

Hello, I am currently taking 1.5mg of Lorazepam daily. I started taking it because I had severe akathisia from SSRI withdrawal and it was simply the only thing that helped. I have been taking it for a month at varying doses (I know that is not good to do but in the beginning I was hoping I could do without).

I am now having problems with interdose withdrawal, or maybe I should say interdose-inefficacy as the akathisia symptoms reappear once the Lorazepam wears off.

I am currently not planning to taper, so I am sorry to put this here, but I wondered if a cross-over to Diazepam might help with the interdose problems.

Also since I have only been on it for 4 weeks, should I still do an extremely slow cross-over or could I go faster?

I took Diazepam twice and it didnt provide relief from my symptoms as the Lorazepam does, I assume this is because it is not as strong-working in the beginning.

Some help would be much appreciated.

Many Ativan users will dose 3 times a day, have you tried doing this?

Hello Pamster, thank you so much for dropping bye and giving me your input. 

Yes, I am currently taking it at 10am-3pm-10pm but the mornings are hell because it wears off.

Is it very tricky to do the cross-over? Does it not work for some?

I just thought also for the future it would be easier once I am ready to taper off because I can source liquid Valium and not liquid Ativan.

Thanks for letting me know how often you take the Ativan. 

 

I don't believe the length of time you've been on the Ativan will play a role in your cross, the issue is Diazepam takes longer to build up in the blood so this is the reasoning behind the slow crossover, slowly add the Valium while withdrawing the Ativan so you won't be slammed with symptoms while in a deficit.  If you're planning to go on 5 mgs of Diazepam you could do this in 2 stages so it won't take that long to do the cross, maybe a couple of weeks.

 

When you tried the Diazepam how much did you take and how long did you give it before you gave in and took the Ativan?

 

You should be aware that the most common complaints about crossing over to Valium are depression and sedation.  Most who attempt this will push through and come out the other side just fine but some are unable and will go back to their original benzo.  I hope the Diazepam will address your issues but since each benzo has a slightly different method of action its difficult to say for sure it will.

Thank you so much again for the thorough reply, I am extremely thankful...

 

I read from Ashton that all the benzodiazepines bind to the exact same receptors and that there is basically no difference, only in potency. Has that been overruled and is not true anymore?

 

In the past I have taken the benzos erratic, it is only now that I have realized that I need to find a stable schedule if I want my CNS to stabilize. I took 5mg Diazepam one day and when it didnt work, I took 1mg Ativan, maybe an hour later and that worked. I am very new to this and didnt know much about benzos and how they act at all, so I thought the Diazepam simply doesnt work for calming the akathisia. I guess this might still be the case if the benzos all have different properties.

It is just because of the akathisia is so horrific and I want it to settle as fast as possible I thought providing  my brain with a very constant dose would be better in that case.

Hmm ... but your post makes me think that maybe Diazepam might not work as well for my akathisia... difficult to find out I guess..

Does the depression and sluggishness lift after completing the cross-over or does it stay with some? Is that because people react differently to Diazepam or has it to do with the taper.

There are so many unknowns once you are in psych drug land

You're correct, benzo's bind to the same receptors, this has not been overruled, I'm referring to the basic differences in the drugs themselves, each is different from the other and many members can feel the difference by how it makes them feel.  This is how the drug companies make their money of course by putting in different ingredients to distinguish their drug from the next.

 

The Diazepam will likely help with the akathisia once it builds up in your system, your previous experiment didn't work because it takes days and weeks for Diazepam to build up to the level you would need to help with this.

 

How and the way we react to benzo's is difficult to predict.  From what I've read from other members the sedation and depression can last a few weeks, past the crossover but then it does settle down, but predicting if it will affect you this way or how long it will last is impossible so as with everything else in this process, you have to experiment and it can be painful because you're the subject of this experiment. 

 

I just realized you said you take 1.5 mgs of Ativan a day, not sure why I thought is was .5, you know you're going to need to go on 15 mgs of Diazepam, right?

Neon, I was on the exact dose of Ativan you are on -- 1.5 mgs 3x a day. I found the interdose wds (anxiety, agitation and strangely, akathisia) to be so distressing that I crossed over to valium. I swapped out .5 mgs of Ativan for 5 mgs of valium every two weeks until I was on all valium. As Pamster mentioned, initially valium makes you very tired. I didn't get depressed -- just so tired I was falling over my fee. But that passed after a couple of weeks. I felt pretty chilled on 15 mgs of valium, divided into 3 doses. And the valium took away my akathisia. But I was intent on tapering, so I didn't stay there long. About a month as I recall. Then I began my taper, following Ashton.

 

So, hope this helps. Getting off Ativan and onto valium was a very good move for me. I eventually went to dosing valium 2 x a day as I tapered down.

 

I just wanted to add one thing. Beta blockers are often prescribed to help akathisia. I started a beta blocker (coincidental) at about the same time I crossed over to all valium and I'm not sure which drug -- the bb or the valium -- was responsible for calming down my akathisia. So that's something else to consider and maybe discuss with your doc.

 

Best to you,

 

Katz

Thank you so much for all the valuable input Pamster and Oregonkatz.. I think I can deal with some tiredness and depression, as I am feeling really bad all the time anyways right now, I think I will be able to take it to provide my CNS with some more stability. I just think the up and down of the Ativan in my brain is probably not good to calm down the CNS to finally have it heal enough to stabilize and make the akathisia go away.

Oregonkatz, I am so sorry you too had akathisia, it is truly a horrible symptom. I am glad you recovered though, that gives me immense hope.  Was yours physical or mental akathisia? I have mostly mental akathisia, like a doom cloud is hanging over me, intense inner restlessness, panic... it is hard to bear.

So if I got it right I will cross over over a time of 6 weeks, always replacing half of a dosage with Diazepam and then waiting for a week, I saw it like that in chart. I am far from stable but I think I wont really get to stable until I can give my brain some breathing time to stabilize completely on the Diazepam. And then I will begin my taper.

Dear Oregonkatz, I saw you mentioned you had a very difficult Valium taper. What were your main symptoms if I may ask?

Hi Neon. My akathisia was physical, couldn't sit still . . . pacing . . . wanting to leap out of my skin . . . feeling desperate . . . rls at night.

 

Yeah my valium taper was a dumpster fire after 5 mgs. I just went too darned fast. I followed Ashton and her drops are too big/too fast for me. I wish I had cut them in half. But I didn't know that I was such a sensitive little flower lol.

 

My s/x were horrid nausea (couldn't eat, lost 40 pounds) , dizziness, headaches and a general all-over-the-body intense malaise. At its worst I described it as my body wanting to vomit itself. I had mental s/x also -- I got loony about one thing or another -- my car, crowds, bridges, my coffee maker. Also I had a lot of derealization -- am I an alien? Have I wandered onto the set of the wrong play? Is this my body? All this was caused by too-rapid reductions. And once I got "in the weeds" no amount of holding fixed things. So if I have any advice it would be go as slowly as you need to. I had a few hints that things were not going well for me just before my last drop . . . but I ignored them. You see, my reductions had been easy-peasy until then.

 

So, hope you do well, Neon. 

 

Best,

 

Katz

I have one more question for all of you knowledgable people out there.

Since I am on benzos only for a month.. do you think, if I wanted to, I could do a faster taper or should it be super slow still?

I am so scared not to stabilize my akathisia while on the benzos. It might be a very bad idea I admit, I just wondered what you think. I read many success stories and it sprung out to me that some only started healing once they were off the drugs and I am quite a severe case so I am just scared I cant stabilize due to tolerance etc as long as I am on the benzo.

Hope to hear your opinions.

 

We'll typically suggest short time users taper faster than those who have taken the drug long term, we hate to see someone taper longer than they were on the drug but only you know how much you can stand in terms of withdrawal symptoms.

 

I disagree that healing only begins once we're off the drug.  When you take the drug, your brain adapts by making changes, when you taper the drug, the brain begins the process of rebuilding and repairing so healing is happening.  Of course, once off the drug the healing continues, this is why there can still be pain after you're drug free. 

I think I will try to crossover to valium too.

I have reached a wall where I don't get calm anymore and sleep is disrupted more and more.

I'm so overstimulated I got all sorts of backpain due the constant stress.

 

I take 3x0.79mg Lorazepam daily and 0,395 at night together with 0,39mg Lormetazepam.

When I do, I will follow this manual:

 

https://www.benzoinfo.com/ashtonmanual/chapter2b/#schedule7 and edit the dose.

 

 

Hopefully this is better to taper because I don't have normal days anymore.

 

 

I read a little bit about the taper plans you advise. I am currently on 0.75mg Lorazepam (I managed to reduce it to that in the last month with minor symptoms. When I tried to go to 0.5 I got the akathisia again. Currently I take 3 quarters. Via the direct taper I would cut 1/4 every two weeks or so. My question is does everyone get interdose withdrawal? Because the titration I dont think I will manage to do and from what I read many with Ativan have problems with interdose withdrawal once they go lower. If I switch to Valium, the switch alone will take as long as I am on the Benzos and I am scared it doesnt work out well for me. I am just scared I guess. Maybe you wise and experienced people have some advice.

From what I've read most members on the shorter acting drugs get interdose so they typically dose Ativan 4 times a day, Valium would help but even Professor Ashton suggested dosing 2 times a day using Valium according to her tables. https://www.benzo.org.uk/manual/bzsched.htm#s8

 

If you're getting symptoms by reducing a quarter mg at a time, I wonder if you might want to slow your taper down, most find this becomes necessary as they get lower.  I know you've been on the drug for a short time but if your body is not handling a fast taper then you can slow it down to hopefully minimize the akathisia. 

 

Have you thought about asking your doctor for smaller dose pills to you can make even smaller reductions by cutting your pills?

At the moment I dont have problems with interdose. I take a quarter twice daily, roughly 12 hours apart. How can I decrease the reductions? I dont think I can half the quarters and still have a reliable dose. I understand Ativan is not fat but alcohol soluble. Is there a recipe of how I can make a liquid from Ativan? I already take the smallest pills available so I cannot ask for smaller from my doctor.

Valium is of course an option, I am just scared I dont tolerate it or that it doesnt help the akathisia as much as Ativan.

Ativan (Lorazepam) is available in liquid form if your doctor will write you a script  https://dailymed.nlm.nih.gov

 

You can make your own home brew. Titration FAQ's  http://www.benzobuddies.org/forum/index.php?board=164.0

 

You can also get a jewelers scale and weigh your doses.