Need to get off lorazepam, zolpidem and Seroquel to get ECT - ASAP!

I had a meeting today with a ECT nurse who told me that I would have to basically get off lorazepam, zolpidem (Ambien) and Seroquel prior to getting ECT for severe, chronic depression.  I am currently taking 2 mg. of lorazepam divided into 5 doses each day, 10 mg of zolpidem at night for insomnia and 200mg Seroquel at night for bipolar disorder.  These are prescribed by my GP at present because I haven't been able to find an ongoing psych doc so I guess I am going to have to make these changes on my own (eg, without valium).  BTW, I have been on the lorazepam for more than 10 years, zolpidem for a few months, and Seroquel for over a year.

 

I am really scared about going through withdrawal because I've been on the benzo. so long and am already very depressed and anxiious. (I was on klonopin for a few years before the doc switch me to ativan/lorazepam.) I meet with the ECT doc on Feb. 27 and want to make some progress towards quitting by then.  I've read a lot of the posts and some of what is on the Internet (eg., Ashton Method) and am pretty confused considering the other 2 drugs I need to get off of as well.  Anybody been in a similar situation and have some advice for me?

 

Thanks

Kathie 

hi welcome to the forum - we do not recommend getting off all drugs at once.

 

ect - is not sure what that is - excuse my ignorance.

 

a moderator will be by to help you with your taper or if you chose titration.

Hi Kathie, I'm so sorry you are having such a difficult time. I know clinical depression from personal experience, so my heart goes out to you.

(Silver, ECT is electro-convulsive therapy)

Well, like Silver said, we don't recommend going off all 3 drugs at the same time. I don't know how much time you have, but done correctly, it could take a few months even to get off just the ativan. 10% every week or two is the rate recommended. That would be about .25mg a cut. so if you are doing this weekly, it would take 8 weeks.

I don't know about the ambien I"m pretty sure it's the same taper rate as benzos. I personally wd seroquel 100mg by tapering 25mg every two weeks. I did it simultaneously with my klonopin taper, but I DO NOT recommend this.(and I had slowed my klono taper way down while I did it.) I hadn't been on either drug very long, and I think I had it easier than most.

Do you know aprox. date when you will be getting the ECT? I'm sure you want it done sooner rather than later.

Take care, Linda

 

Thanks for the quick reply, Linda.  You are right that I want to have the ECT done as soon as I am able.  The nurse actually wanted me to go into the hospital for the pre-treatment work ups next Monday and have my first treatment on Wed. (2/13).  But when I learned that I wouldn't be able to take any of my psych meds - esp the ativan - the day before until after the treatment, I freaked.  I know I am dependent on them because of the difficulty I have had reducing how much I take. It took me a month to reduce from 2.5mg to 2mg.  I requested a meeting with the ECT doc to discuss this and the earliest they could schedule me was Feb. 27.  Assuming I am able to wait until then depression-wise, I guess the first treatment could be March 3.

 

Also, re the Seroquel, an urgent care doc increased my dose from 100mg to 200mg on Feb. 1 so I figured it was best to go ahead and drop back to 100mg which I did last night.  I could taper slower but I thought that since I hadn't been on the higher dose very long it wouldn't hurt.  What do you think?

 

Kathie

beeper many of us have been labeled bi polar - it is a very popular diagnosis that leads to lots of very profittable drugs and also works to diminish a persons confidence in themselves.

 

i don't know what your symptoms are but if they are related to lack of sleep it is important to realize that not sleeping can make a person feel crazy.

 

until you receive ect you may benefit from sleep therapy and cognative therapy using techniques to help you center yourself and sleep.

 

coming off drugs will exacerbate sleep issues and coming off of drugs will mimic any mental health issues.

Hi Beeper,

 

Welcome to BBo.

 

I know very little about Seraquil, so will have to leave advice about this drug to others.

 

Your dose of benzos is not very high, but certainly significant, and withdrawal should not be taken lightly. There is huge variability in what rates can be managed by individuals, but quitting your benzos over a few weeks does seem very optimistic. From what you have written, it appears that you do not have to quit as such, but you cannot take your benzos for at least a full day before treatment. What might be more manageable is for you taper down as far as you can with the Lorazepam, so that you are stopping your benzos from a lower dose when it comes to the ECT treatment. You might also enquire for how long you must not take the Zolpidem before the ECT treatment. You might be able to take an extra dose of Zolpidem nearer the time of the ECT treatment to offset the fact that you have stopped the Lorazepam. Lorazepam has a much longer half-life than the Zolpidem, so you might find that you can take a dose of Zolpidem much closer to the time of treatment - but you will need to discuss this with your doctor! What is the pattern of treatment with ECT? How long between each treatment? I am assuming that you will have time to go back to your benzos between each treatment - yes?

Hi Kathie,

If you only have to be off your meds for two days, I think maybe you could just be off them for two days and start them again. I don't think this would cause you too much problems except maybe a sleepless night. It's good you went back to 100mg seroquel, that should be no problem since you just very recently went up.

I'm not telling you not to taper and get off your meds. But what I"m saying is I don't think you neccessarily have to wait until you are completely off to get your ect. You would just have to go off for those two days. You have to be in the hospital anyways, right? Maybe they can give you some vistaril or a pre-surgery med the night before. I think after, they will probably give you something. I am not terribly familiar with the process.

I think this really best to discuss your plans with the nurse and the doctor involved with your ect. It's really beyond our scope here! But we will certainly offer you any encouragement along the way, and I wish you the best of luck. Of what I know of current ECT, it is very effective, and nothing like we all remember from the movies long ago!

Keep us up to date, ok? Let us know what you will be doing regarding your meds.

Linda. 

 

 

 

Didn't see your post Colin, when I posted. 

Thank you for all your thoughtful responses.  I wish I could talk to the ECT doc before Feb. 27 and ask some of the questions you have asked about how long I need to be off ativan and zolpidem before the treatments.  They are scheduled on Monday, Wednesday and Friday mornings (5:30am!)  You have to go into the hospital 2 days before the first treatment for a complete physical workup.  You are allowed to go home after the first treatment (as long as someone can take you and stay with you) but many stay in the hospital the whole week.  I don't think I would like that (psych ward and all).  I'm thinking that if I have my first treatment on Wednesday, I'd be able to take some level of meds afterward and until Thurs. evening but nothing from bedtime on.  I picture myself roaming the house all night and anxious about the treatment to come.  What a time to have to stop taking anti-anxiety meds!  Anyway, it's basically every other day that I have to be off the ativan, zolpidem and Seroquel.

 

BTW, I don't remember if I mentioned that the urgent care doc put me on 175mg of Wellbutrin which I started on Feb. 1.  Some other places I've read that Wellbutrin can make you anxious.  Maybe I should stop taking it until after this ECT thing is over?  The doc said I should take it when I asked her during my visit ("should I wait to start the Wellbutrin until after ECT" and she said "No"), but I don't know that she's that familiar with ECT procedures.  I thought all licensed psychiatrists would know the basics but now I'm not sure.

 

Kathie

Wellbutrin may inititially make you anxious (I'm on it), but it usually goes after a few weeks. So the doc or nurse that told you that you can't be on meds for the ect, did they mean wellbutrin too? If it's a different doc than your pdoc that told you that, I would ask that one. I know you said you cant' see him, but if I were you, I would call his/her office and say you need tapering advice now, that if you wait til your appt on the 27th, it will be too late for that advice.

Linda - You must be psychic.  I already put in a call to the ECT nurse but she only works MWF.  She already told me that only the doc could tell me what meds I would be taking before treatments and the schedule.  Maybe she can get him to talk to me on the phone.  There aren't enough psych docs here for the population and waits for appts. are up to 3 months so I don't have high hopes that he'll make/have the time to talk to me before 2/27. 

 

Kathie

Linda - You must be psychic. 

 

A little bit.

Hey Beeper, welcome again from me Janus.  Could you put your signature line on, so we know just what dosages you are on of your current meds.  That would be helpful as we all walk together in this journey.  Let us know what you find out from the nurse.  Thanks. Janus

How do I add a signature line?

Click on "profile" on the green button bar below the "shout" box.  then click "forum profile information" on the left side of your profile page. Scroll down near the bottom and enter your text!

. . . . and don't foget to click 'Change Profile' at the bottom-right!

Good point, I always forget to mention that!

i forgot to say that to - it is so automatic to me.

First, congratulations, eljay.  You must be so proud of yourself.  And relieved that the worst is over (I hope).

 

Second, I added my med. info to my profile but am not sure how to get the text to show up here.  I'll sign off as I usually do and keep my fingers crossed.

 

Finally, I talked to the ECT nurse to get more information about what drugs I need to stop taking when before each ECT treatment and the info. was no different that when I met with her:  the doctor will have to tell me that because it will be individualized and he won't tell me over the phone.  So I still have to wait until 2/27.  She did suggest that I call my primary care doc and ask her for a weaning schedule.  I guess I can give that a try and see if it's something I can get over the phone from a nurse.  I have been trying for nearly 2 weeks to get through to the appointment desk to get an appointment but my calls haven't been returned. 

 

However, I'm not so sure now that I want to consider ECT after what I've read about the symptoms benzo. addiction can cause.  I think I should start a new thread just about weaning off the ativan and hope that my depression doesn't worsen while I'm doing it. I actually had a decent day yesterday though sleep was still fitfull and sweaty. Ewww. 

 

Kathie

It would be interesting to me to know when the depression started and when did  you start on the benzos and all the other stuff?  Do you remember the timeline for any of this or did you start on the benzos for depression.  If you have already stated that I am sorry if I am making you repeat.  Don't expect the worst when you start withdrawing from benzos...a gradual slow safe supported taper is very manageable, although one can expect some bumps along the way especially in one's most vulnerable spots.  Only  you will know if you need the ECT, though you may want to know that benzos can cause depression.  We are here to support you.  Do you live alone, do you have friends? etc.  Janus

Thank you Kathie!!

You have a very good point about benzo and depression. I was put on klonopin for insomnia, and almost immediately developed depression. I thought it was from other factors but hindsite I see it was from the Klono. It was moderate to severe for several months, then it suddenly lifted halfway thru my taper, never to return.

Like Janus said, it would be very interesting to hear your depression history. When it started, etc.

If you are not suicidal, or completely incapable of self care, ECT might not be the answer for you at this time if you are having second thoughts. It's certainly something you can put on hold until you feel sure it's the only answer.

That you actually had a window of feeling half decent for a brief time may be a sign that you can recover without the ECT.

Tapering benzo may increase the depression, but this can be a very common wd symptom, not neccessarily a worsening of primary depression. 

Don't let anyone talk you out of, or talk you into ECT! It's your life and you need to do what you feel is best for you. 

History of depression:  Several depressive periods that went undiagnosed and untreated while in college (40+ years ago); 2 suicide attempts. No others that bad until about 1989 when I was diagnosed with clinical depression and put on Prozac; klonopin was added shortly thereafter because of inability to sleep.  Prozac worked well for about 1 1/2 years but eventually I had to admit that it wasn't working any more.  Was put on many other anti-depressants over the next 5 years or so (Paxil, Zoloft, Serzone, Effexor, Wellbutrin, as well as the old line drugs like trazadone and elavil). During that time I weaned off of klonopin with ativan substituted.  (Never did a doc say I might become addicted to either of these drugs or what the side effects might be.  Grrr.)  Finally in 1998 I couldn't work anymore because my depression was so bad.

 

Nothing has worked for long and I've been with 3 different psychiatrists. In 2003 I was dx'd with bipolar disorder, the antidepressants were dropped and I was tried on all the bipolar drugs: lithium, depakote, neurontin, topomax, lamictal, seroquel and others, in various combinations.  My last psych. doc said they had tried all the available drugs though they wanted to try higher doses and different combinations.  Mostly because I ran out of money to pay for the drugs I left that doc and am now looking for a new one. 

 

I have had several losses in the last 2 1/2 years, the latest being the unexpected death of my only sibling and last family member just after Thanksgiving in 2007.  I'm sure that greatly contributed to the recent downward spiral that led me to seek ECT as a last resort.  Having read here and other places that benzo.s can cause depression has me rethinking the ECT and hoping that getting off ativan will help alleviate my symptoms.  I am seeing a counselor 1/week but have only seen her 3 times so far so I don't know how much help that is going to be.

 

Hope I haven't depressed anyone.  It's made me a little upset just writing this sad history.  I really am desperate to either be gone from this life or have one worth living again.

 

Thanks for caring.

Kathie

Hi Kathie,

 

I read your post and it reminded me a little bit of myself. I have developed depression when I was in college, also. It was triggered by a lost love and then everything else piled on. I did not know what was happening to me and didn't know how to deal with it. Anxiety went along with depression. Was put on meds, too. Only when I met my husband I started feeling better and got off of them. He was a great support at that time. But mind you, I always had that low level depression, (melancholy) even when I was at my best.

 

Several years later, in a new country and with the stress of failing marriage, little kids, no family nor support, etc. I started  having all of those symptoms back. And was put on A/D's and  klonopin. Only elavil (sp.?) worked for me for a very short time; the rest of A/D's either made me sick or did not lift any depression. That's when I realized that I will probably always have depression, due to my nature, and that no pill can really cure it. I just needed to find ways to do things to make me feel better (this is the hardest part - I know what tends to uplift my spirits but it's not easy to have that happen due to life "constraints"). I also know that being on medicines made me feel worse than when I had my normal depression (someone once called it - "organic").

 

I am not saying to you to get off the meds. But I wonder how you'd feel if you weren't on them, and if you had a good support (family, good friends) at the same time. Also, you just lost a sibling! In my opinion, anybody with any depth in feelings would be grieving right now. Grief will make your depression and anxiety worse, that goes without saying.

 

Some of us are just more emotionally fragile than others. We just have to accept it and deal with the hand we are dealt. I know, easier said than done... But what's our choice?

 

Please, accept that you are grieving now. Time will be the healer. Believe, also, that you can have a content life. It's never too late to make baby steps in changing how you see the world. I am on that path and you can be, too.

 

Love,

tanya 

Wow, two powerful posts back to back.  Tanya, your words of wisdom to you Beeper may be just what the doctor ordered.  I agree that some people are just more sensitive ( which is not negative) and this is at the same time a blessing and a curse.  I'm sorry for you recent loss Beeper, and agree that this is exaserbating everything.  I'm glad you are seeing a counselor, is s/he good?  I hope to be able to support you as best as I can, and you, too, Tanya.  Powerful posts.  Janus

I so agree with you Janus. Beautiful posts.

Kathie, I"m very sorry about your sib. I have only one also, and dread the day I lose him. Thank you so much for sharing your story, I know it must have been hard to put it all down in writing like that. But that can also be good, letting you know where you started from, and where you are now.

We are here for you!

many of us were placed on benzo's and other pills because life events were over powering.

 

but keep in mind all people have major life events and at that time they become accidental addicts - not by there choosing but because it is cheaper to drug someone then to help them walk through the pain.

 

i hope you have an effective counselor that can help you with coping strategies.