Grace62: Help with daughter

[Grace62]

Hi everyone -

 

I am a parent of a 20 year old daughter who is currently on 0.25mg of Lorazepam in morning (for last 3-4 weeks) and 15 mg of Remeron for 6 weeks (following 4 weeks of 7.5mg Remeron) due to anxiety and possibly depression.  She was placed on these drugs in order to save a University term - which will be completed successfully in about 12 days.  I deeply regret her starting any of these drugs and am deeply concerned about these drugs and their impediment of actual healing and just how hard it will be to get off them.  As she is not actually all that much better - is definitively not herself at all - I am hoping she will opt to get off these drugs now and heal without drugs - even if it takes longer.

 

I would like experienced advice on how to achieve this with the least possible distress.  I have read clearly the need for the slow taper.  It does appear that she has reached tolerance with Lorazepam and it does appear to cause depression in her rather than help as an add on for Remeron.

 

My questions are -

 

a.  For the Lorazepam which is a tiny dose - does she really need to switch to Diazepam (equivalent dose would be about 2.5mg) prior to tapering down.  Or would it be acceptable to just taper to 0.125mg Lorazepam for 2 weeks then down to zero ??

 

b.  Is it best to get off the Lorazepam first then the Remeron (especially since it appears it will be quite quick to get of Lorazepam relative to Remeron)?

 

b.  As she has only been on Remeron for about 2.5 months total - will this make the withdrawal any easier??

 

Thanks for any help - if this should be posted elsewhere then please let me know.

Once my daughter starts the process I will have her create her own account for sure.

 

 

[IHadPassion]

Based on my experience with both Lorazepam and ADs:

 

a.  Yes, I would highly recommend crossing over to a longer half-life benzo as soon as possible.  Lorazepam dependency is probably one of the worst drug dependencies possible. 

 

b.  Really depends on the individual, but I believe Lorazepam and benzos in general are the worse evil.

 

c.  Probably, in my experience, ADs take a longer time for the brain to become dependent on.  I imagine 2.5 months on Remeron will not present much of an issue.  2.5 months straight on Lorazepam, though, is sufficient time to develop a serious, debilitating dependency. 

[mammaP]

Hi Grace, I have moved your post here to our benzo forum for Wellness to take a look, she is our benzo expert and will be able to advise on the lorazepam taper. Usually we suggest tapering the anti depressant first but after such a short time it may be best to taper lorazepam first.  I will leave you in Wellness' capable hands. When your daughter is ready she could start another topic in the intro forum for help with tapering remeron. 

[Fresh]

Hi Grace , welcome to the site.

 

As bubble noted , we usually recommend tapering the most activating drug first , i.e remeron

See "Tapering Multiple Psych drugs , Which to Taper First?" here http://survivingantidepressants.org/index.php?/topic/2207-taking-multiple-psych-drugs-which-drug-to-taper-first/

 

Given the short amount of time on remeron , your daughter may be able to taper off faster than usual. She could start with a small decrease (2mg) and see how she tolerates it.

Ideally , she will be able to taper off in less time than she has been taking it.

 

Please see "Tips for Tapering Remeron" here http://survivingantidepressants.org/index.php?/topic/5301-tips-for-tapering-off-remeron-mirtazapine/

 

This is your thread to use as a journal and ask questions. Hopefully your daughter will be able to use

the site herself soon.

 

Best wishes , Fresh

[Wellness]

Hello, and welcome to SA.

 

I think you are wise to ask these questions so early in the process, her chances of getting off the medications quickly and painlessly are increased by the short duration, the "small doses" and her young age.  It is irresponsible to prescribe lorazepam to be taken every day for weeks to someone who is newly diagnosed as depressed.  It looks like she has a trigger happy doctor on the prescription pad.

 

Regarding Lorezepam, it is possible to build tolerance in a few weeks so she may feel some withdrawal, or then again, she may not.  It's not a hard science.  The best option, in my opinion, is to lower the dose a little and see whether she is having some withdrawal symptoms, (headache, nausea, panic attacks, suicidality).  She could try to go from 0.25 mg to 0.2 mg a day for a few days and see, then make another small cut if that is successful.  In terms of percentages it is a 20% reduction but given that she has only been on it for a short time, it may not be a problem for her.

 

Switching to a long acting benzodiazepine for a long taper is not optimal for someone who may not have build tolerance.  If she can come off the lorazepam without too much trouble, it may be her best option.  you question as to whether going to 0.125 mg is a possibility, it is a 50% and is pretty fast, it's best to try a smaller cut and see how she reacts for a few days and re-asses from there.

 

Normally, the most activating drug should be tapered first but given that she has only been on lorazepam for a few weeks, going off the lorazepam first might prevent here from developing tolerance.  My feeling is that there is some cross over actions between Remeron and lorazepam so that she could get some withdrawal symptoms from lorazepam while coming off the Remeron, or vise versa.   Which ever one you choose, it may be wise to finish the taper of the first before coming off the second, otherwise it can be extremely confusing not knowing which drug is causing withdrawal symptoms and she may have to reinstate, sometimes at an even higher dose.  From my personal experience, it was almost 10 days after I took a cut from Remeron before I  experienced the strongest withdrawal symptoms.

 

It may be easy for her to get off both meds.  There is a memory effect (kindling) with these drugs in that the first time one gets off of them, it's easier, then it gets progressively harder to come off of them.  She may be able to come off the drugs easily.  

 

I hope she is willing to come off of them.  

 

If you have not already done so, I suggest you take a look at the Ashton manual.  Here is the link:

 

http://www.benzo.org.uk/manual/

[Grace62]

Thank you everyone.  Yes it is my hope that she is willing to come off them too as I do not see much improvement and the reason she ended up on them was an acute high stress and abusive relationship coinciding.  She desperately wanted to save school term (she is a very highly accomplished student) and so there seemed no choice but to go this route.  However I want my daughter back.  I worry how much she trusts the psychiatrist who is prescribing and needed alternative advice.  I do realize this is her choice and decision - I am reaching out to just try to find options and helpful advice.

Lately I have felt that the recent decision to go to 0.25mg Lorazepam instead of just 0.25mg a few days a week was a bad decision.  Due to the short half life - I think we are creating an addiction.  She does have anxiety each morning which she takes the Lorazepam for but I believe it is getting worse because she is adapting to the Lorazepam and is actually in a bit of a drug withdrawal.  After the first week of every day of lorazepam she had a very tearful week and she seems more depressed with more Lorazepam.  She has not opted to take more than one dose a day and that is our goal to keep the drugs steady right now for next 10days til end of school.  I would prefer to get rid of the Lorazepam first as it seems to have complicated things with out helping much.  Then deal with the Remeron withdrawal all on its own.  I do know that if the Remeron withdrawal becomes too much the preference here is to put her on diazepam to help (sigh - we'll cross that bridge when we get to it).

 

Question - I have looked at the Ashton manual and their taper for lorazepam is to switch to diazepam (so 0.25mg lorazepam to 2.5mg diazepam) then to go to 1mg  diazepam then to zero.....is this likely to be too quick then ?? I don't want my daughter to be in too much distress - she will likely think it is disease and not withdrawal .....

 

Thanks you for this forum - I too am needing support at this point.

[Wellness]

The morning anxiety is very typical of lorazepam withdrawal.  Also, lorazepam is a real depressant for me, I'm not surprised that she is worse and crying a lot, lorazepam has that effect on me too.  

 

The Ashton manual has her switch to diazepam, it's much better for someone who has been on lorezepam for a long time, but she may not need to do the switch, but you will see that if she has strong withdrawal symptom while trying to decrease the dose. 

 

Taking lorazepam every day increases her chances of developing tolerance very quickly, that is for sure.  Does the tearfullness coincide to when the effect of lorazepam wears off (3-4 hours)?  She could try to split the dose and take half of a 0.25 mg at her regular morning time and another dose when that wears off to see if that makes a difference.  If so, then splitting the dose and taking a bit every 8 hours might help her.

[Grace62]

Thank you Wellness 

 

Yesterday she took none.  But today she took the 0.25mg in morning.  It is not clear that in the morning she is anxious more depressed.  I am trying to talk with her about that.  I am hoping she will tell her docs that the lorazepam is making her depressed - Xanax months ago sent her to the hospital in three days because of how dark it made her.

 

If she decides to get off lorazepam then I will insist she starts her own account to get help from those that have been there.  

 

Is it possible that she won't have much wtihdrawal because she has the remeron on board still ?

 

6 more days til end of university term...

[Grace62]

Hi again 

 

If my daughter decides to get off lorazepam without switching to diazepam but remaining on remeron ...

How long should each taper be if she tolerates it well ?  1 week ?  2 weeks ?

how long after being off the benzo with the depression start to fade ?  This will be important as it will be a time to aim for 

[mammaP]

Wellness has advised to take half the dose in the morning and see how she feels, if she is ok then take other half 8 hours later and see how she feels. Keep an eye on her and you might be able to see when she starts to feel depressed and anxious. It could be quite quick if she doesn't have any withdrawal from the half dose. It is impossible to put a time on it because we don't know how dependant her body has become.