I’ve been asked this question a few times – and it’s certainly a big an issue for anyone who’s ever had a benzodiazepine prescribed for them (just look at the growth in ativan dependency treatment information).
Once again (I’ve posted this list before), these are all the drugs that I’m talking about. They all belong to the benzodiazepine family, and the withdrawal symptoms are all the same:
|Drug Name||Common Brand Names|
|Alprazolam||Helex, Xanax, Xanor, Onax, Alprox, Restyl, Tafil, Paxal|
|Bromazepam||Lectopam, Lexotanil, Lexotan, Bromam|
|Brotizolam||Lendormin, Dormex, Sintonal, Noctilan|
|Chlordiazepoxide||Librium, Risolid, Elenium|
|Clonazepam||Rivotril, Klonopin, Iktorivil, Paxam|
|Clotiazepam||Veratran, Clozan, Rize|
|Diazepam||Antenex, Apaurin, Apzepam, Apozepam, Hexalid, Pax, Stesolid, Stedon, Valium, Vival, Valaxona|
|Etizolam||Etilaam, Pasaden, Depas|
|Flunitrazepam||Rohypnol, Fluscand, Flunipam, Ronal, Rohydorm,|
|Lorazepam||Ativan, Temesta, Tavor, Lorabenz|
|Lormetazepam||Loramet, Noctamid, Pronoctan|
|Midazolam||Dormicum, Versed, Hypnovel, Dormonid|
|Nitrazepam||Mogadon, Alodorm, Pacisyn, Dumolid, Nitrazadon|
|Oxazepam||Seresta, Serax, Serenid, Serepax, Sobril, Oxabenz, Oxapax|
|Temazepam||Restoril, Normison, Euhypnos, Temaze, Tenox|
The drug that I was prescribed was lorazepam – the brand name is Ativan.
The first “invented” benzo was Librium, and all the drugs are basically a monification of this one. The lorazemam I was on is a newer version, is 25X more potent, and has a slightly different half-life (the time it takes to get half of the drug out of your system – generally though of as the “active” life of the drug).
These two factors seem to be the primary differences between all of the bezos. This link on Wikipedia gives you a good overview of the potency and elimination half life of the dozens of different benzodiazepines.
Typical Benzodiazepine Withdrawal Symptoms
The benzodiazepines have three major “downsides” to their use – and these can manifest themselves in as quickly as three to four weeks of continuous use:
- Dependence – Within that window of time (3-4 weeks), your body will grow to depend on the presence of the drug. Without the drug, you’ll go through real physical withdrawal symptoms.
- Tolerance – Over the course of a few months, you’ll need progressively higher doses of the benzo to get the same effect. I went from 0.5mg to needing 2.0mg (4X increase) over the course of 6 months.
- Withdrawal – You cannot quit benzodiazepines cold turkey. The side effects of doing this are really severe – siezures and death have been reported. While withdrawing on the drug slowly, you’ll still likely have some paradoxical side effects. The most common one for sleep patients is increased insomnia – for me, the withdrawal insomnia was worse than the insomnia lorazepam was prescribed for in the first place! Other withdrawal effects often reported include tremors, fearfulness, upset stomach, and muscle spasms.
How I Weaned Off Benzos
When I say wean off slowly, I mean really slowly. I took my cues from The Ashton Manual in the UK, where extensive study of benzodiazepines has taken place. Read the manual – it’s worth it. And you’ll find out how little your doctor really knows about these drugs – it seems the Europe is more enlightened about their use than we are.
These are the steps I took to wean off the drug:
- Although the manual suggests that you slowly move over to Valium (a much less potent and commonly available benzodiazepine, so you’re better able to manage the taper), my GP was unwilling – so I had to take the teeny tiny lorazepam pills and divide them. Fortunately they are available in 1mg and 0.5mg doses.
- I took the 2mg dose (2 x 1mg pill) and divided one of the 1mg pills in half. That’s 1.5mg. I took this for 6 weeks.
- I then went down to 1mg (took only 1 pill) for 6 more weeks.
- I got a supply of 0.5mg pills, and cut my dosage down to 0.75mg for 4 more weeks.
- Down again to 0.5mg for 4 more weeks.
- Here’s where it got hard. I cut down again to 0.25mg, and the insomnia got so bad I had to go back up to 1.5mg again to get some relief. Then I started all over again.
- Went down to 1mg, then 0.75mg, then 0.5mg, then 0.25mg.
- Same thing. Had to go back up to get relief.
- Finally went all the way down again to 0.25mg and stuck it out. The insomnia went away in a couple of weeks.
- After 4 weeks on 0.25mg/night, I cut back to taking it every second night.
- Then every third night.
- Then once a week.
- Then I stopped.
- I imagine the whole affair took me about 9 months. 2 or 3 of these were repeating the doses trying to get through that 0.25mg barrier.
I’ve tried taking lorazepam again on the occasional night, but I find it does nothing at all for me. Actually, when I measure it on my Zeo, I can clearly see that it doesn’t make me sleep any better, and actually cuts my deep sleep in half.
So I’m now off it forever.
Would I Do It Again
No. I’d stick out the initial insomnia and find some alternative ways to help it.
Where To Get Help
I’d head to the Benzodiazepine Withdrawal Support group on the web. Great advice and great support.
**PS: Just read this one this morning: Ambien and Restoril have been linked to a higher death risk! They’re both short-acting benzodiazepines. Get off benzos now!
**PPS: If you’re currently on a non-benzodiazepine – commonly called a “Z-Drug” – like Sonata (Zaleplon), Ambien (Zolpidem), Imovane (Zopiclone) or Lunesta (Eszopiclone) read this post – they’re more like the benzodiazepines than you think!!