Author Topic: To reinstate...or not to reinstate?  (Read 14603 times)

[Buddie]

To reinstate...or not to reinstate?
« on: April 17, 2012, 12:12:00 am »
Before I knew very much about how involved all of this is I was questioning whether or not I should reinstate and another buddy (thank you!) sent me these 4 links that helped me decide.  Wanted to share them with you so you can also make an informed decision for youself.  I bold highlighted things I thought were significant.  I personally decided not to reinstate based on how far out I was.  Hope this helps.  Good luck!


From http://www.benzo.org.uk/ashsupp11.htm -
Reinstatement, updosing

A dilemma faced by some people in the process of benzodiazepine withdrawal, or after withdrawal, is what to do if they have intolerable symptoms which do not lessen after many weeks. If they are [...] taking benzodiazepines, should they increase the dose? If they have already withdrawn, should they reinstate benzodiazepines and start the withdrawal process again? This is a difficult situation which, like all benzodiazepine problems, depends to some degree on the circumstances and the individual, and there are no hard and fast rules.

Reinstatement after withdrawal? Many benzodiazepine users who find themselves in this position have withdrawn too quickly; some have undergone 'cold turkey'. They think that if they go back on benzodiazepines and start over again on a slower schedule they will be more successful. Unfortunately, things are not so simple. For reasons that are not clear, (but perhaps because the original experience of withdrawal has already sensitised the nervous system and heightened the level of anxiety) the original benzodiazepine dose often does not work the second time round. Some may find that only a higher dose partially alleviates their symptoms, and then they [...] have to go through a long withdrawal process again, which again may not be symptom-free.

Pharmacologically, neither reinstating nor updosing is really rational. If withdrawal symptoms are [...] present, it means that the GABA/benzodiazepine receptors have not fully recovered (see above). Further benzodiazepines cause further down-regulation, strengthen the dependence, prolong withdrawal, delay recovery and may lead to protracted symptoms. In general, the longer the person remains on benzodiazepines the more difficult it is to withdraw. On the whole, anyone who remained benzodiazepine-free, or has remained on the same dose, for a number of weeks or months would be ill-advised to start again or to increase dosage. It would be better to devote the brain to solving individual symptoms and to finding sources of advice and support. Advice about how to deal with individual symptoms is given in the Manual (Chapter 3).



From http://www.non-benzodiazepines.org.uk/withdrawal-guide.html -
Updosing and reinstating

We have found that reinstating is most successful if it is carried out within 2 weeks after complete discontinuation of benzodiazepines. Generally reinstating is discouraged beyond 2 weeks after discontinuation as reinstating beyond this point in time may not always work and sometimes in rare cases may even make the individual feel worse. However, there may be circumstances where reinstating is required for example a person may have been cold turkeyed and is suffering extreme withdrawal effects such as psychosis or intolerable symptoms of anxiety or insomnia and may be acutely suicidal. However, due to the unpredictability of reinstating which may not always fully alleviate withdrawal symptoms the choice to reinstate beyond 2 weeks completely off of benzodiazepines must be made by the individual.

If a person is going to reinstate after complete discontinuation of benzodiazepines and have been off of benzodiazepines for more than a couple of weeks and have made the decision to reinstate, it is better to introduce benzodiazepines gradually rather than picking a dose out of thin air and going straight on it. One reason for doing it this way is that a person can judge what their tolerance level is. So a person may want to start off taking 1 mg of diazepam and increasing the dose by 1 mg each day until they find relief of intolerable withdrawal symptoms. This approach is recommended by Dr Reg Peart for people when they have decided to reinstate.



From http://www.benzosupport.org/notes_on_reinstatement.htm -
Notes on Reinstatement.

CAUTION: A person should always consult with their doctor before making any changes to their medication.

What is Reinstatement? Reinstatement is going back onto a benzo after a cold turkey, detox or very rapid taper.

What is the purpose of a Reinstatement?  The purpose of reinstatement is to bring very bad withdrawal symptoms under control so that a person can start a slower taper off benzos that will hopefully make the withdrawal process more bearable and allow the person to be more functional as they do it.

Does it work? Observation of people reinstating suggests that reinstatement after being off benzos for less than 4 weeks is more likely to work than reinstatement months or years after ceasing the drugs. However, these numbers are very variable and other issues, like being on other psychiatric drugs can factor in.

What benzo do people reinstate to?  People either reinstate to the benzo they were on or they talk to their doctor about reinstating to one of the benzos with a longer half life like Valium. The tapering advantages of Valium are discussed in the Ashton Manual. If someone is unable to use Valium, they would probably be better off using Klonopin, rather than Ativan or Xanax. Both Ativan and Xanax have extremely short half-lives and can produce difficult interdose withdrawal symptoms.

How much benzo do people reinstate to? The purpose of reinstating is to get the withdrawal symptoms under enough control so that a person can embark on a slow taper. The amount needed is likely to vary with the individual – it may be the same as they were taking prior to the cold turkey, a little more or a little less. Dr. James Thomas in Ohio has been known to reinstate people onto Valium 2mg every 3 hours until the person feels well. Dr. Peart, of VOT, suggests 1-2mg/day of Valium until the person feels better. We have no scientific data to support either approach so one must simply talk to their doctor about this.

Are there are problems with Reinstatement that should be considered?

Yes there are.

-    Reinstatement may make some feel better but the taper and recovery that follows may [...] be hard

-    Reinstatement may not make a person feel better and then they are faced with a difficult taper anyway.

-    In some cases a reinstatement can make a person feel worse than they did prior to the reinstatement. Anyone contemplating a reinstatement should discuss a plan for getting off again with their doctor in case they find themselves in this situation.


What is the general feeling about reinstatement at the Yahoo Benzo Group?

It is generally felt that if a person has recently come off benzos rapidly and is extremely unwell, then reinstatement may be an option to discuss with their doctor.

It is also felt that if a person has done a reasonable taper and is many months or years into recovery that reinstatement should only be considered if the person has absolutely no quality of life.


Is there any scientific evidence about effectiveness of Reinstatement? No, there doesn’t appear to be any scientific evidence that helps with the decision making about reinstatement. 


And finally from a BB thread - http://www.benzobuddies.org/forum/index.php?topic=44288.20 
« Last Edit: April 17, 2012, 06:55:48 pm by [Buddie] »
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: To reinstate...or not to reinstate?
« Reply #1 on: April 17, 2012, 12:17:39 am »
Excellent post Sunnygirl.  When I started my reinstatement thread here in this section yesterday, I remembered seeing some of those links you just posted, but couldn't remember where I'd seen them.  Glad you posted them here, although I am one who did benefit from reinstatement and I think there are legitimate reasons to do so, as I describe in my thread.   Main thing is to be educated about the pros and cons. Since you were 2 months off, it probably makes sense to have not reinstated, although I have read of some who did at a later juncture and were able to taper slowly after "stabilizing".  How are you doing now?

[...]
« Last Edit: April 17, 2012, 09:58:32 am by [Buddie] »
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: To reinstate...or not to reinstate?
« Reply #2 on: April 17, 2012, 01:55:59 am »
Hi Sunny,

Thanks for posting the reinstatement info that I had sent you.  I know some might have felt I shouldn't provide that information to you, but I felt that you should know.  Reinstating sounds like all your troubles will be over, but for some as the Ashton Manual states it doesn't work.  I feel the farther one is out the harder that reinstating could be. Within 2 weeks I believe is what the time to do it is advised. Sometimes there are other options than reinstating, maybe getting on an a/d or using some medications the Ashton Manual suggests.  As   Colleen a friend of mine says, there are always options to help us thru this, it is just knowing about them.

I don't recommend anyone c/t but there are times when it happens even under a Dr's care. I was having such paradoxical reactions - adverse reactions that it was a matter of my continuing to have cardiac issues, or get off of it quickly.

My 4th month my mother passed suddenly and my feet got knocked out from under me. I felt I was drowning and didn't know if I could make it thru.  I didn't know if I could reinstate due to the benzos did make me so ill. But how would I go on?  A tapering friend sent me most of the info I passed on to you Sunny, then a c/t friend told me what she was taking to prevent her from drowning - Lyrica.  All of us want to be medicine free - want for our bodies to heal naturally, but c/t is so harsh that sometimes it alone makes that impossible. Then times when a death of a love one happens it is too much on the nervous system. 

Medicine other than turning back to benzos is there to help.  I got some negative remarks from some people about my going on Lyrica, but then they weren't in my shoes, their mother hadn't died. I couldn't hold my taper, I couldn't take benzos for a short time.  We each have to do what we need to do to survive this.  I'm here at 7 1/2 months c/t, 3 1/2 months of my mom being gone - I am surviving and having windows at that.  I physically feel healthier than I did when I was on benzos. I have w/d sxs but I am better off benzos. Some day I will be off Lyrica by tapering off it the right way.

Remember there are other options beside reinstating, it is just knowing about them.
[...]  :angel:

Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: To reinstate...or not to reinstate?
« Reply #3 on: April 17, 2012, 09:47:27 am »
Thank you for a useful post, [...]. It contains some very interesting points of view.

I've read most of those paragraphs before but until you drew them together I hadn't properly understood their common message. (Blame my lack of concentration and inattention!) Thank you for doing the work.

-[...]
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: To reinstate...or not to reinstate?
« Reply #4 on: April 17, 2012, 06:09:09 pm »
Thank you sunnygirl :angel:

At first, I wanted to just go back on to make it STOP. the horrible w/d symptoms but......
I am glad I didnt. I truly believe I will heal in 2 yrs just as anyone else.


And, we wont even bring up the dangers of Kindling!!! Could be even worse than c/t.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: To reinstate...or not to reinstate?
« Reply #5 on: April 17, 2012, 07:02:21 pm »
You're welcome!  Really the thanks should go to Ms. [...] [...] as she passed along this great info to me.  I just reposted.  So, thank you, [...]!   :thumbsup:  I don't know why anyone would say this info shouldn't have been shared. 

These were great points:

Quote
Reinstating sounds like all your troubles will be over, but for some as the Ashton Manual states it doesn't work.

Quote
Remember there are other options beside reinstating, it is just knowing about them.


 :thumbsup:
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: To reinstate...or not to reinstate?
« Reply #6 on: January 21, 2013, 11:07:40 pm »
One of the mistake i made is ..reinstate the benzo after 1 year of complete c/t withdrawal ... which makes my symptom even worse. reinstate after 2 months or more is most likely not going to help and probably  will make things even worse ... at least thats what it did to me.

Can anyone tell me about...is there anyway to minimize the side effect of Reinstating? ... or there nothing can be done but waiting?
« Last Edit: January 21, 2013, 11:30:43 pm by [Buddie] »
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: To reinstate...or not to reinstate?
« Reply #7 on: January 21, 2013, 11:45:16 pm »
One of the mistake i made is ..reinstate the benzo after 1 year of complete c/t withdrawal ... which makes my symptom even worse. reinstate after 2 months or more is most likely not going to help and probably  will make things even worse ... at least thats what it did to me.

Can anyone tell me about...is there anyway to minimize the side effect of Reinstating? ... or there nothing can be done but waiting?

The only thing I can think of is to check in with the tapering boards to be sure you are tapering properly.  Or reach out to others who have reinstated.  Sorry, I'm not much help!
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.