Diazepam withdrawal causing psychosis - advice please

[Amnesia]

SWIM is prescribed diazepam for a transient movement disorder with muscle spasticity, usually for a few months every year.

She is currently coming off it again after 11 weeks on 30mg daily, and is struggling terribly with the withdrawal, even though the dose is being reduced gradually.
For a long time she never suffered withdrawal but the last couple of times it has been awful.

Is it just SWIM who becomes terrified (far exceeding what anyone would call anxiety) and delusional when in withdrawal, or is this common? She does not mean just depersonalisation and derealisation (she suffers from them anyway and can cope with them), she means genuinely believing in frightening things which aren't, and can't possibly be real, but seem so during withdrawal. She is so afraid (of nothing she can identify) that this is the fourth time she has written this post in as many days, and every other time she has been too scared to submit it.

Her doctor told her the dose could be increased again if her mental health began to deteriorate but, as much as SWIM doesn’t want to go crazy, she really wants to get off the diazepam.

If anyone out there can give advice on what can help prevent or minimise this psychosis SWIM would really appreciate the help – she is already on a mood stabiliser/anticonvulsant (lamotrigine), she cannot take antipsychotics or antidepressants, and valerian and skullcap have proven ineffective.
The only options SWIM can see are; an extremely slow withdrawal schedule which may minimise but prolong the mental health effects, or simply riding the insanity through again.

She says many thanks in advance for any help, advice or other options.

[missparkles]

Sparkles had this very problem, she found that reduction was a nightmare.
The only thing that helped was using liquid diazepam, then she could reduce the dose by 1 mg at a time.
The reduction was the same, just at 1mg doses.
Don't know if this helps but she also started relaxation techniques, this helped calm her enormously. She used a disc that talked her through it.
Taking deep breaths (yeah sounds ineffective) but it's not, as soon as that fear, which starts in the pit of your stomach and works it's way out, as soon as it begins, take long deep breaths.
It's hard to panic when you're breathing really deeply. And that feeling of dread, is just an extension of that fear.
Sparkles found if she could prevent the terror escalating, the psychosis was greatly reduced.
Obviously don't continue doing it, you'll hyperventilate, and that makes the anxiety worse.
I really hope this has been of some help, I know how awful quitting these drugs can be.
Hope you feel better soon?
Sparkles.

[Amnesia]

SWIM says thanks very much for the fast reply and that its nice to know she is not the only one who feels these things.

She has been meditating and singing for many years so she is very good at controlling her breathing. She too has found it effective in controlling the dread which threatens to engulf her, classical music helps her too.
But the things SWIM can't control are the delusions and hallucinations. At the beginning of reduction she can rationalise them, but eventually she can't tell whether they are real or not and the horror just feels as if it will never stop.

SWIM will talk to her doctor about reducing by 1mg at a time, she thinks he would be happy with this suggestion.

Thanks again Sparks

[Ontherooftops]

Swim has had a few withdrawls from different things in his life, and the withdrawl from his combined habit of diazepam and clonazepam far... er... outshone any other withdrawl experience, even in comparison to a massive opiate addiction.

Withdrawl from benzodiazepines was purely psychotic hell, with a bit of ungodly muscle tremors thrown in the mix.

Taper slowly, don't rush it too much.

The insanity will pass, slowly the beautiful world will come back into focus, keep this in mind.

Swim found the most comforting thing to be done about the delusions was opening up a word document or taking a piece of paper and letting the psychosis fall out on to the page in a stream of consciousness manner. Actually, some of the best poems he's written were produced by the bizzarre disjointedness of those horrible times.

Also swim recommends Yoga, which helped incredibly with the muscle stiffness and helped him find his center when the withdrawls were too great to reach a comfortable state in his meditative practices.

Good luck, you are not alone in the way you feel, and you will get through it.

Reputation Comments on this post:

	Interesting, helpful, supportive advice
	Excellent advice promoting theraputic distraction and calming techniques

[Amnesia]

SWIM says thank you very much for the advice and support.
Unfortunately SWIM's problems are exacerbated by serious mental health problems - she has a nasty habit of falling into mixed manic psychosis.

Originally Posted by Ontherooftops

Swim found the most comforting thing to be done about the delusions was opening up a word document or taking a piece of paper and letting the psychosis fall out on to the page in a stream of consciousness manner. Actually, some of the best poems he's written were produced by the bizzarre disjointedness of those horrible times.

SWIM does this too, and it's great advice. She's doing it everyday at the moment and, like SWIY, it is during these times that some of her best work is produced - although it does tend to be rather dark and disturbing.

Originally Posted by Ontherooftops

Also swim recommends Yoga, which helped incredibly with the muscle stiffness and helped him find his center when the withdrawls were too great to reach a comfortable state in his meditative practices.

Unfortunately SWIM can't do yoga anymore due to a complex multitude of physical health problems, but she does find meditation to be helpful during the initial stages of withdrawal.

SWIM says thank you for making her feel less alone.

[Dickon]

Amnesia,

My cat found that after once developing an addiction to benzodiazepines he developed withdrawal symptoms far quicker subsequently. This might in part to do with the particular benzodiazepine used, but I think is in part to do with the body adjusting in some way. I am thus not all that surprised you are having problems after 11 weeks on 30mg diazepam a day.

For cat, when he was in bad withdrawal he simply had to stay in bed as the anxiety was such that any social interaction was just unbearable and terrifying. He'd watch TV series he'd download to pass the time. Cat never experienced delusions or psychotic symptoms, although he once had a fit when withdrawing cold turkey, and wonders if these aren't connected with an existing condition being exacerbated by the withdrawal.

I don't know if it's even possible, but a little light exercise is likely to be beneficial. Also, if you can bear in mind that the things you are anxious about are not real it might help. Keep telling yourself "this is just drug withdrawal and it will pass". I don't think there is much in the way of pharmacotherapy that is useful here, simply adjusting the speed of the taper to make things bearable. I'm possibly going to project an answer that was suitable for my cat and might not be appropriate for you, but I'd suggest tapering fairly rapidly. Benzodiazepine withdrawal is potentially dangerous even occasionally fatal, so medical supervision is definitely recommended. Although Ashton Manual-style tapers (i.e. very slow ones) are almost certainly beneficial for many people who have been on these drugs for decades, 3 months of use does not require an overly-extended taper. Of course if any underlying medical conditions predispose you to fits this course of action should not be considered, and a slower taper would be more appropriate.

I think it is important to find a balance between the real risks of an overly quick withdrawal and the problem of exacerbating a dependence by unnecessary prolonged use of the drugs.

I understand this course of action would not minimise or prevent the bad effects, but it would minimise the duration of them. It might be worth considering if another medication is more suitable in future for your movement disorder that does not leave you with these awful withdrawal symptoms.

One thing to remember is that they do pass, albeit somewhat more slowly than one would want. Sorry I couldn't be of more help. I also think the meditation will help, especially if you can establish deep, regular breathing.

Best of luck, and I hope the symptoms get better quickly

Dickon

Reputation Comments on this post:

Excellent post. Personal experience, advice and harm reduction all in one.

[Amnesia]

Thank you very much for the advice.

It is due to SWIM's serious mental health problems that a slow taper is being used - her doctor doesn't want her to go insane again. However, SWIM is already toying with the idea of a much faster taper - she shouldn't have to worry about seizures due to her lamotrigine.
In her previous experiences (with rapid reduction or cold turkey cessation - she didn't know at the time how dangerous cold turkey was) the severe psychosis usually passed within 3 months. She is wondering if this would be preferential to several months of milder symptoms.
Damn her for her indecisive nature

Originally Posted by Dickon

It might be worth considering if another medication is more suitable in future for your movement disorder that does not leave you with these awful withdrawal symptoms.

SWIM has already, and quite forcefully, told her doctor she will never go back on them and he will have to find another medication to treat her physical problems. Unfortunately, the other 3 skeletal muscle relaxants in current use are contra-indicated by other problems SWIM has
She feels sorry for her doctor sometimes. He does try his best with such a problematic patient.

SWIM says thanks again, every reply makes her feel better and less alone.

[needtostop]

cold turkey withdrawal from alcohol or benzos can be lethal. It's one of the few withdrawal types that can actually kill you. all benzo's must be slowly and carefully tapered to avoid delerium tremens or seizures.

[Amnesia]

^^^ SWIM knows this.
She is not considering going cold turkey, and did not mean to give the impression she was considering this option. She is merely considering a slightly more rapid reduction schedule than she is on at the moment - which would all be done under medical supervision.
This was discussed with her doctor today and he agrees that it might be a better option than drawing it out over several months, which is the current plan. She will be giving it a great deal of thought before she meets with him next week, which is when they will decide which way to go. As previously mentioned, her doctor said the dose could be increased in the event of severe deterioration in mental health.

The only reason SWIM has to reduce at such a ridiculously slow rate, much slower than that of a normal person (according to her doctor), is because she has severe mental health problems.

Also, as mentioned in previous posts, SWIM is on an anticonvulsant medication which also works as a mood stabiliser, her doctor is confident that this will protect her from seizures and help to prevent the more severe psychosis i.e. delirium, delusions, hallucinations and thought disorder.