Depression may be caused or aggravated by chronic benzodiazepine use, but is also a feature of the withdrawal syndrome. Depressive symptoms may appear for the first time after withdrawal, sometimes after a delay of a few weeks, and it can be severe and protracted for some months. It is not clear whether people who have had depression before, or have a family history of depression, are more prone to this complication, and its causes are not understood. As discussed in Chapters I and II, benzodiazepines disrupt the function of many neurotransmitters and hormones and depression could be the result, for example, of low serotonin activity combined with the stress of withdrawal. If severe enough to require definitive treatment, the depression in withdrawal responds to antidepressant drugs and/or cognitive therapy and usually diminishes gradually over 6-12 months.

What is the most important information I need to know about Ativan withdrawal?

Usually they will only be required temporarily, but they can sometimes ease a difficult situation and enable the user to proceed with the withdrawal program. ” This question is commonly asked by patients withdrawing from benzodiazepines. They seem to be prone to colds, sinusitis, ear infections, cystitis, oral and vaginal thrush (candida), other fungal infections of the skin and nails, cracked lips, mouth ulcers and influenza. Also common are complaints of adverse reactions to antibiotics used to treat some of the bacterial infections.

Other drugs

Antidepressants are the most important adjuvant drugs to consider in withdrawal. As mentioned before, depression can be a real problem in withdrawal and can sometimes be severe enough to pose a risk of suicide, though this is unusual with slow tapering. Like any other depression, the depression in withdrawal responds to antidepressant drugs and is probably caused by the same chemical changes in the brain. There is a school of thought, mainly amongst ex-tranquilliser users, that is opposed to the taking of any other drugs during withdrawal. But suicides have occurred in several reported clinical trials of benzodiazepine withdrawal. If depression is severe during benzodiazepine withdrawal as in any other situation, it seems foolhardy to leave it untreated.

Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.

” This question is sometimes asked by people embarking on a benzodiazepine tapering program. In contrast, others are so against drugs when they decide on withdrawal that they are loth to take anything, even the benzodiazepine withdrawal simplest pain killer. All such drugs should be avoided as they only substitute one type of dependence for another. Depression in withdrawal responds to antidepressant drugs in the same way as depressive disorders where benzodiazepines are not involved.

DRUG INTERACTIONS

The only other benzodiazepines with similar half-lives are chlordiazepoxide (Librium), flunitrazepam (Rohypnol) and flurazepam (Dalmane), all of which are converted to a diazepam metabolite in the body. The slow elimination of diazepam allows a smooth, gradual fall in blood level, allowing the body to adjust slowly to a decreasing concentration of the benzodiazepines. The switch-over process needs to be carried out gradually, usually in stepwise fashion, substituting one dose at a time. Many people have suffered because they have been switched suddenly to a different, less potent drug in inadequate dosage because the doctor has not adequately considered this factor.

Tapering off supratherapeutic doses

Ativan can lead to dependence even if you take it exactly as prescribed. Patients should drink 2-4 litres of water per day during withdrawal to replace fluids lost through perspiration and diarrhoea. Multivitamin supplements and particularly vitamin B1 (thiamine) supplements (at least 100mg daily during withdrawal) should also be provided to help prevent cognitive impairments9 that can develop in alcohol dependent patients. In rare cases, alcohol withdrawal can be life-threatening and require emergency medical intervention. Hence, it is extremely important to assess patients for alcohol dependence and monitor alcohol dependent patients carefully.

Signs and Symptoms of Ativan Withdrawal

• A slow tapering regimen, in my experience, is easily tolerated, even by people in their 80s who have taken benzodiazepines for 20 or more years.
• After a month or so, your brain gets used to sending off more neurotransmitters just so some can get past the benzodiazepine blockade.
• If total abstinence is causing psychological distress, some people may aim for a reduced dose.
• Physical exercise may prolong withdrawal and make withdrawal symptoms worse.
• Protracted symptoms continue to fade over a period of many months or several years.
• The Short Opioid Withdrawal Scale (SOWS, p.37) is a useful tool for monitoring withdrawal.
• During withdrawal some patients may become disruptive and difficult to manage.

If, as in many cases, an antidepressant drug is already being taken along with the benzodiazepine, it is important to continue the antidepressant until after benzodiazepine withdrawal is complete. Withdrawal from the antidepressant can be considered separately at a later stage (See Chapter II, Schedule 13). A third important practical factor is the available dosage formulations of the various benzodiazepines. In withdrawal you need a long-acting drug which can be reduced in very small steps.

COMMON

Nevertheless there is no magic rate of withdrawal and each person must find the pace that suits him best. People who have been on low doses of benzodiazepine for a relatively short time (less than https://ecosoberhouse.com/article/why-is-my-vision-blurry-after-drinking-alcohol/ a year) can usually withdraw fairly rapidly. Those who have been on high doses of potent benzodiazepines such as Xanax and Klonopin are likely to need more time.

• However, such drugs can have serious side effects (motor disorders like Parkinson’s disease) and are not recommended for long-term use or as a substitute for benzodiazepines.
• All those extra chemicals flood your brain, and the excess activity causes symptoms like anxiety and sweating.

It may take a long time for these people to regain, or attain, full confidence in themselves. Benzodiazepines undoubtedly have effects on the endocrine system, but these have not been closely studied in humans, either during long-term benzodiazepine use or in withdrawal. Many women complain of menstrual problems but these are common in the general population and there is no clear evidence that they are directly attributable to benzodiazepines.