Need Advice, Long Story

If it was me...
 
I would stop the Zolpidem and start the Diazepam at the same time. If you stabilize then I would start a wean of the oxazepam slowly over a 1 month period.

Warning - The drs would NOT recommend this as it could possibly get your blood pressure too low. However any faster and you could have a horrible withdrawal. The key is to monitor your blood pressure closely. That is how drs here have trained me when I had to come off benzos and it works. Do NOT let your systolic bp (large number on top to drop below 100. Always take your bp the same way in the same position each time. Always set or lie for at least 2 minutes before taking a bp. The ebook has an excellent section on taking bp. It is based on how the drs trained me as well as some medical journal articles on the subject.

Now, I am going to explain this in a different way. As you wean any psych med the blood pressure will elevate as the withdrawal kicks in. It varies from person to person but normally as your systolic gets above 115 the symptoms worsen. As you increase your diazepam the bp will reduce but should not drop below 100. Bp varies with what you eat, how much salt and water intake you have, etc so I never rely on just one reading.

So this is a balancing act. Stop the Zolpidem and as the bp starts to rise above 115 or 120 9depends on the individual) you start on a low dose of diazepam. If the symptoms and high blood pressure continue then take a little more diazepam. Once you get the hang of that and get a good feel for how much diazepam you need tp keep the Zolpidem under control then you can start the weaning of the oxazepam. This takes patience. I must stress that I am NOT a dr and in no way am qualified to treat a patient. this is lust how I have been taught to approach the issue. Most drs would rather see someone have withdrawal then risk too low a bp so they error on the side of caution. If you wish you can stop both the Zolpidem and oxazepam at the same time and start using your diazepam to help you as your symptoms escalate but you may have some bad times during the day. In either way if your bp gets high take a little diazepam and if the bp gets too low hold off on any more diazepam. Stay well hydrated and stay away from things that are stimulants (list in the ebook) like caffeine, sugar or salt.

Watch out for dizziness on standing, loss of balance, loss of peripheral vision as these are all signs of low blood pressure. I don't know Roald. As I think about it while typing this I worry about you being able to balance the bp at the same time as tapering the benzo/z-drug. It would be safer to drop both meds and use the diazepam as needed for symptoms. The decision is yours.

Hi Roald,

I was reading through your thread here and sorry you're going through this. And despite the fact that FH has given me lots of helpful advice over my time here, I know it's always unnerving to make such big decisions about medication feeling like you're just jumping into deep murky water and not knowing whats down there either way. I know this sounds silly but take everything FH has provided for you here, mull it over, and then trust your gut. You're the only person who is in your body and knows exactly how you feel and what your limits are. Therefore only you can make the right call. 

 

The only thing I wanted to add was re: your brother advising taking Atenolol. I would disregard this. I actually took beta blockers during the first 5 months or so of my hellish Cymbalta withdrawal and it was truly a godsend for the constant daily panic attacks I was getting. But there are 2 types of beta blockers: selective and non-selective (referring to cardio since this is what these drugs are labeled for). Atenolol is selective so unless you take very high doses, it only blocks the beta receptors around your heart. Non-selective (like propranolol) blocks beta receptors all over your body so it can help mitigate all sorts of physical, adrenaline-related anxiety effects (would not help though with suicidal thoughts or things like that). Also want to note that beta blockers will lower your blood pressure at certain doses and even at low doses will keep your heart rate low. Definitely something to be concerned about while you're on other meds that do the same. 

 

Hope that helps!

"trust your gut. You're the only person who is in your body and knows exactly how you feel and what your limits are."

Oh so true. Great advice.

Great that you kept a log... and data is like catnip to me so I had to graph it!!

 

So let's take a look at the result...

 

https://ibb.co/7YT9Wvd

 

Look at that huuuuge dip. Look at the black line - this is a 7-day trend line which is the best choice for this sort of withdrawal. This needs to be a lot more linear that it is.... Sorry should state that this is mg across the y-axis and days across the x-axis.

 

That is for sure something to do with what you are feeling, along with the updose of the Citalopram...

Guys,

 

Thanks a lot and Frog thank you my friend. 

 

So, I had a panicky last night. Ended up on the ER. 

 

This morning I took 4mg Diazepam and my body couldn't handle it. My body began shaking, body temperature superlow, slow breathing, sweating, anxiety. I called my doctor and said I cant handle the Diazepam. She told me bluntly: then I dont know what to do anymore. Thanks a lot, with doctors like these I don't need any enemies. 

 

So, I think I did 2 things wrong: I dropped the Oxazepam wayyyyy too rapidly which I compensated with Zolpidem to get through the panick attacks. 

My plan now is: get on a long ass taper for Oxazepam and Zolpidem withdrawal. 

 

Guess I should start with 30mg Oxazepam and take it slowly from there. This will take me months but I will see what to do with work, my health is more important right now. The only 2 things I cant find are good tapering schedules to get of Oxazepam and Zolpidem. Does anybody know where I can find them? Btw, I have asked to see another doctor. This one has put me through hell. 

So, I think I did 2 things wrong: I dropped the Oxazepam wayyyyy too rapidly which I compensated with Zolpidem to get through the panick attacks. 

My plan now is: get on a long ass taper for Oxazepam and Zolpidem withdrawal. 

 

 

 

Absolutely. That graph should show you all you need to know. Benzo withdrawal is no joke. This is for sure the right thing to do...

 

Hat will help you with the right way to withdraw. He will be more use than a doctor at this juncture. Knowing his history, not only does he understand it well, but having gone through what he did, the last thing he (or any of us) wants, is for you to suffer the same way.

 

We'll see you well friend.

I have informed numerous well reviewed private clinics to help me with detox. They are familiar with Benzo detox. I really need supervision/a doctor there to make sure im safe. This morning trying something new, the diazepam, I felt like dying and called 112 again. Can't continue like this. I hope one of these clinics can take me asap. The public ones don't look so good.. 

 

My doc has been prescribing me oxa and zolpidem since the beginning of February this year. Now she acts like I can't be in withdrawal. Im furious and sad at the same time, especially for my partner who has to put up with me. 

Time for a new dr for sure.
 
One note on the diazepam, it sounds like you took too high a dose for your body. You might try about 1 mg or even 1/2 mg.
 
I am an old man and remember well the days when drs would say "follow the teaspoon/teacup rule". In the 1800's most medicines came in the liquid form so a dr would prescribe say 1/4 cup of a medicine. The teaspoon/teacup rule was that for any new medicine start with a lower dose than prescribed (eg. a teaspoon full) and then slowly work up to what the dr prescribed.  That term stuck with a lot of drs until the 40's and 50's. A slow buildup in dose minimizes the risk of side effects, drug interactions, etc.
 
A very slow wean of the Oxazepam and Zolpidem would be the best. Zolpidem needs to go first. I have had a lot of experience with benzo withdrawal both personally and in helping others. To me the best and safest way is water titration. I think I put a section on it in the ebook but will check. Basically it is dissolving your doses in water and reducing the concentration so slowly you do not have any significant withdrawal but the down side is that can take year or more depending on the benzo and dosage. I will be back in a little bit with more info.

Time for a new dr for sure.
 
One note on the diazepam, it sounds like you took too high a dose for your body. You might try about 1 mg or even 1/2 mg.
 
I am an old man and remember well the days when drs would say "follow the teaspoon/teacup rule". In the 1800's most medicines came in the liquid form so a dr would prescribe say 1/4 cup of a medicine. The teaspoon/teacup rule was that for any new medicine start with a lower dose than prescribed (eg. a teaspoon full) and then slowly work up to what the dr prescribed.  That term stuck with a lot of drs until the 40's and 50's. A slow buildup in dose minimizes the risk of side effects, drug interactions, etc.
 
A very slow wean of the Oxazepam and Zolpidem would be the best. Zolpidem needs to go first. I have had a lot of experience with benzo withdrawal both personally and in helping others. To me the best and safest way is water titration. I think I put a section on it in the ebook but will check. Basically it is dissolving your doses in water and reducing the concentration so slowly you do not have any significant withdrawal but the down side is that can take year or more depending on the benzo and dosage. I will be back in a little bit with more info.

 

Hat, Im not taking this doc seriously anymore. Want to get my letter to get put to another doc and she will never see me again. 

 

Considering what you said, could it be possible that I felt so terrible because of the 4mg I took in once instance? I can always try 1 mg in this case. 

 

When you look at the withdrawal process, would it be easier to get on diazepam and taper down to 0 compared to oxazepam?

 

She prescribed me 2x2MG five times a day. This seems like a lot to me?

 

If you were on my crossroad, would you pick the way to continue oxazepam which I am familiar with or try and give the diazepam another shot?

 

As always, many thanks for all the help. You guys DO know more than docs (I can't believe this, I have been following this woman blindly for quite a while). 

Yes, I would try 1 mg of diazepam and see how it goes. It is easier to wean off of diazepam than any other benzo but oxazepam is not too bad.

2x2MG five times a day seems like a lot to me as well.

If it were me I would just slowly wean the oxazepam but having said that I would probably be better of switching to diazepam first. lol

I am going post my weaning procedure in just a minute.

The titration system for cutting benzo dosages is as follows.
 
This is a procedure called water titration. If gives you good control of your withdrawal. I have used this the last 3 times with no withdrawal as have many others.
 
1st - Place three days dose to dissolve this in 600 ml of water and shake well. Poor in a storage bottle (1 qt jar) and store in refrigerator.

 

2nd - Every 6 hours, take the bottle out of the refrigerator, shake well and pour out 50 mls and drink it . Usually this can be measured using a graduated shot glass (yes they do have shot glasses that are calibrated this way) and I have also seen tiny measuring cups at Wal-Mart. Some people use a large syringe from a vet supply store or farm supply store to measure the 50 mls.

 

Do this four times per day.

 

I measure my doses using something like this however mine are marked in 1 ml graduations ...
 https://www.amazon.c...1021225&sr=8-28

 

3rd - To decrease a dose make a new batch, shake well and  remove 1 ml from that 600 ml solution. Then add 1 ml of water back to the bottle. You have just removed 0.17% of the medicine. Still take 50 mils 4 times per day.
4th - with teach new batch remove one ml more than the batch before. With time you can try a little faster rate (2 additional mls each time, 3 mls, etc). You can tell when you Are going too fast when you don't sleep well, especially if you have stressful dreams. If symptoms develop they will be minor. Just hold steady at your current dose until your symptoms go away (1 or two weeks)/ You can then start weaning again but at a slightly slower rate.
 
Caution - Remember, benzos do not fully dissolve so always shake the solution before making cuts or taking a dose.
I have been a member of benzobuddies since 2004 and that is where I learned about water titration. My current situation is my fourth benzo withdrawal since and I have never suffered. I have also had two pdocs that have encouraged this method as well.

 

Example;
Lets say I am on 3 mg of lorazepam per day.

 

Step 1 - Dissolve 9 mg of Lorazepam (a 3 day supply) in 600 ml of water.

Step 2 - Take 50 ml of this solution every 6 hours. This will provide you a more stable blood level of your benzo rather then taking it every 8 hours.

Step 3 - Once you decide to start tapering make up a new batch at the same 9 mg in 600 ml of water BUT this time remove 1 ml of the solution and replace with one ml of pure water and continue taking 50 ml every 6 hours. This is a 0.17% drop. Very small. If after a few days you feel no withdrawal then you can try dropping 2 ADDITIONAL mls each time. If after a few days and no problems then you can try removing 3 additional mls each time.

Step 4 - At some point you will start to notice some light withdrawal, drop back to the previous rate and stay there to stabilize. Once stable then you can continue to drop at a slightly lower rate with little to no withdrawal.

 

So, in my above example, I start by removing 1 ml of water from each batch and if no problems then I will make a new batch and remove 3 mls and replace with water. I was already removing 1 ml and now I am removing 2 mls more so a total of 3 mls. I continue on with the same dose for a few days and if no problem I will start dropping an additional 3 mls per batch. At this point I am already removing 3 mls each time so the next batch I will remove the same 3 mls plus an additional 3 mls. For the sake of this example, lets say at that point I start noticing some withdrawal. I will immediately stay at that dose until I recover. I will then go back to dropping 2 additional mls with every new batch I make. This will then allow me to drop the benzo smoothly will little to no withdrawal.

 

Caution - Benzos do NOT totally dissolve in water so you must shake vigorously before pouring your 50 ml dose. It is recommended to use PEG (polyethylene glycol) to dissolve the benzo because it will totally dissolve in that material. Unluckily PEG can upset the stomach in some people (like me) and then water may have to be used.

 

So it goes like this.
9 mg lorazepam in 600 ml water, take 50 ml every 6 hours.
If no issues then 9 mg lorazepam in 600 ml, shake well, remove 1 ml and add back one ml of water.
A few days later if no issue decide to start removing 2 additional mls with each batch. So make up the 8 mg benzo in 600 ml and remove the 1 ml you were already doing plus 2 more mls and then replace with 3 mls water.
If no issues then go to dropping additional 3 mls with each batch. So remove the 3 mls you were already removing plus an additional 3 mls (total of 6 mls).
If withdrawal starts to show. Stay at that dose until you feel better. Then go back to dropping 2 additional mls with each new batch.
I have done this several times and am aware of several other individuals who have done the same with little to no problems.
There is a new FDA warning that staying on a benzo too long increases the risk of dementia. Benzos are not to be used for a period of more than 4 months and withdrawal should be as quick as tolerated.
 

It is a slow but sure process but allows you to continue to lead your life as you wean. I would be most interested in the detox center's approach to this problem. I only have limited experience with detox centers.

Thanks a lot for the info Fishing!

 

I have taken my last measure. I called my dad. He is a well known cardiologist in Europe but I have never discussed my mental issues with him (ashamed). Untill today. I told him the entire story and we bonded a lot. He has taken me to his home to help and supervize me 24x7 with my start of Diazepam and detox from Zolpidem and Oxazepam. I will start tomorrow. Wish me luck. He will actively non stop measure blood pressure etc. I am in good hands. Still extremely scared to use the diazepam again but with his supervision I feel better about doing it. 

That is fantastic RD. Please keep us informed as to how it goes.

Absolutely - well done. Really well done. that cannot have been easy. Proud of you.

 

As Hat said, please keep us informed - always here for you.

Hello everybody!

 

What a difference a day makes  

 

Monday I took my last doses of zolpidem and oxazepam. I have been taken way too many Zolpidem lately to get me through Anxiety attacks but my dependancy on it increased my anxiety. 

 

Since Mondaynight I havent taken and Zolpidem and Oxazepam anymore. Yesterday morning I began with a 5 weeks detox program starting with 20 MG Diazepam and taking of 20% every week.  Have you guys seen the movie Traingspotting? That's how I felt the entire day yesterday. I literally couldnt focus for 1 minute, couldn't read anything/watch anything, was in heavy heavy withdrawal mode. Because the withdrawal of Zolpidem gives you heavy insomnia I got 3 pills of 25mg Quetiapine for this week. I took one last night and this didn't go well. One hour later I was puking on the toilet, heavy flashes in front of my eyes and had severe muscle spams. Thank god my dad was there. We took another 2mg of Diazepam and one hour later I fell asleep. He has been with me all night, bless him. 

 

However, this morning I feel absolutely reborn! I can focus a bit more, I am feeling happier, less anxious and am able to type this message (which I couldn't have dont yesterday). My dad has been monitoring my BP and heartrate non stop and it looks more than good atm. 

I won't take the Quetiapine tonight however, will use something else for the next 2 nights to sleep. 

 

I will keep you guys updated. Thanks so much for your support and good advice!

 

Love Roald

Great start. You are so blessed to have your father's support. Please keep us posted on his approach and your experience as this is how we learn.

He guys,

 

A quick resume of this week. So I have decided to detox of the high doses of oxazepam and zolpidem this week. At the end of my period I was using 2/3 zolpidems per day to get through the horrible withdrawal and anxiety periods. 

 

What I've learned this far: never touch Zolpidem. Highly addictive and a killer to decrease dosages. With accute withdrawal it will give you insane insomnia and anxiety or even seizures. He also contacted a detox clinic and they work on the exact same way. Starting with Diazepam and reducing it to 0 in five weeks time.  

 

I started this week with the 20mg Diazepam. I took my last dosis of Zolpidem and Oxazepam on Mondaynight. 

 

Tuesday: Started this day with 20mg Diazepam. Was in bed all day watching time tick away. In the night I couldnt sleep. Stayed up 38 and tried seroquel (25mg) which gave me anxiety but after taking 2mg more of Diazepam I could finally sleep a couple of hours. It was by far one of the worst days of my life. The Diazepam however prevents you from getting seizures etc. 

Wednesday: As reported, a good day! Still some anxiety but I could get through. Tried Seroquel again. Insomnia was still there. Stayed up 38 hours till next day 1 AM. 

Thursday: Hard hard day. Was awake for 38 hours due to insomnia. The 3rd day of withdrawal is superhard. Not as hard as day one but still extremely hard. After not sleeping the day before I fell asleep at 2 AM and got 7 hours of sleep. 

Friday: Amazing day. Low to none anxiety. Trying to spread the dosis of Diazepam over the day. Keeping a larger amount for the night. Will use the Seroquel again. 

 

The first five days are by far the hardest, let's hope that tomorrow will be as good as today. 

My dad has been monitoring my BP/Pulse non stop. On Tuesday and Thursday my BP was low. Only thing to do is lie down and keep your legs slightly up with a pillow under them and eat and drink as much as you can. 

My father also gave me supplements everyday and a strong dieet of fish (salmon and herring) and veggies. Strong multivitamins, 2000mg of Omega3, bread with Omega 3 butter and loads of EPA / DPA in it. He is a big fan of Suntheanine and also takes linseed on his bread and highly recommends it after I am of the Diazepam. He also recommends to keep using the Omega 3 butter and supplements as you guys have suggested. He is amazed by the ebook and the good help in it. 

 

Working on the detox with a five week plan. This far I cannot complain. However, the first 3 days I highly recommend to have somebody around how can help you/calm you down and even take your bp/pulse. Keep drinking as much water as you can, do not touch caffeine. I take herbal tea and loads of water. 

Well I can't say I am surprised. yes the Z-Drugs are a bear to come off of. If you can hang in there a couple three weeks things should begin to settle down. You might talk to your dad about trying 600 mg of NAC (N-acetylcysteine) twice a day. NAC increases the amount of circulating Glutamate.



https://www.ncbi.nlm...pubmed/27725170
The anxiolytic effects of NAC were comparable to diazepam.

https://www.ncbi.nlm...pubmed/29045497
modulation of Glu transporter expression may restore Glu (Glutamate) homeostasis.

Well I can't say I am surprised. yes the Z-Drugs are a bear to come off of. If you can hang in there a couple three weeks things should begin to settle down. You might talk to your dad about trying 600 mg of NAC (N-acetylcysteine) twice a day. NAC increases the amount of circulating Glutamate.



https://www.ncbi.nlm...pubmed/27725170
The anxiolytic effects of NAC were comparable to diazepam.

https://www.ncbi.nlm...pubmed/29045497
modulation of Glu transporter expression may restore Glu (Glutamate) homeostasis.

 Fishing, would you suggest starting with the NAC during my detox? I already ordered it. Will have my dad look into it now. 

Yes it should help with the detox.

Yes it should help with the detox.

 

Hat, discussed it with my Dad. He thinks you're a brilliant guy, he doesn't say this very often so take it as a big compliment haha. He also suggests the NAC. 

 

I will start taking the NAC as I am at a 10mg Diazepam daily dosis. The only thing he is unsure about is how high the dosis should be. 

The standard for benzo withdrawal is 600 mg twice a day. It really helps take the edge off. While most see benefits within a few hours it usually takes a couple of days for me.

 

I thank your father for the compliment. I must admit I also am impressed with your dad. Not only for his support of you but also in being willing to listen to someone on the internet and at least consider their thoughts. Your father is exceptional.

 

Keep us posted.

Go Roald go!

 

P.S. Ive been taking Seroquel since mid December or so. The Cymbalta withdrawal gave me terrible insomnia. Ironic because while I was on Cymbalta I slept an insane amount of time. I could sleep 10 hours and then still need a nap during the day. 

Anyway the Seroquel didn't really work for me until 50mg. And even then when my Cymbalta withdrawal was at its worst my sleep was pretty inconsistent. I also remember having some trouble with increased heart pounding when I first started on the Seroquel. I think it takes a little time for your body to get used to it. 

 

Just a heads up though, if you do end up using it on a consistent basis, it can give you rebound insomnia when you try to stop so step down gradually. I'm in this process now. 6.25mg down, 43.75mg to go! lol

Really glad to read your updates RD.

 

It just goes to show when you go about these things in the best way possible, there can be some really good surprises! I think NAC is very much understated and it will be good to see how you fair with it and its respective reduction of symptoms over the next few weeks. 

 

The role of the NAC is specific to REGULATING the glutamate, thus restoring the homeostasis as mentioned in Hat's second citing above. When you have been on an Antidepressant, it messes with the distribution of glutamate in order to suit the changes in synapses. When you stop, the whole thing becomes maladaptive - your brain just hasn't a clue - and yes, the Trainspotting example!! 

 

Please keep in touch - and bless your father - what a guy!

Thanks for the positive words girls and guys! Glad you can recognize the Trainspotting scene IUN, it was really that bad. 

 

Day 5: feeling a whole lot better. Fell asleep last night. Ended up on 18MG diazepam and 1 Seroquel 25mg

 

Frog, the seroquel give me incredible heartpounding the first 2 days, I think anxiety of taking something unfamiliair played a huge role in that as well. I got 7 Seroquel units to get through the first week of rebound insomnia and then I won't get any more. 

 

I will keep you guys updated!

You can't be British and not have seen Trainspotting!

Small update: 

 

Last week when I started the detox the first six days were pure hell. 

 

From Wednesday this week I've been feeling a lot better. No pure anxiety anymore. On 16mg Diazepam daily. Lowering to 12 MG diazepam next week. Seeing a lot of improvement. 

 

I desperately want to work out but I guess I shouldn't. 

 

Will keep you friends updated!

Well done - keep going... Make sure you are ready for your 25% drop of the benzo. Good to have goals, but only proceed if you are ready.

Fishing, an update for you: my dad has spoken to numerous docs in clinics for benzo and Z-withdrawal:

 

They monitor you for a week inside a clinic. They start with a high doze of Valium and taper 20% of per week. For the worst parts they will give you Dormicum to sleep our Quatapine. 

After the week you're dismissed and will be called 3 times a week to check up on you.