Opinions - An Understanding Doctor

[laws0n]

SWIM has been struggling with insomnia for a year now, which has recently turned into anxieity. SWIM has been missing ALOT of school and is just trying to graduate at the moment. SWIM was on a waiting list for nearly 2 monthes for a Phyc. appiontment, and it got cancelled because SWIM's dad got an insurance change.

SWIM has been prescribed alot of stuff that was usless, which included:
Amityptiline
Cyclobenzaprine
A Bunch of restless leg syndrome meds
Eszopiclone (lunesta)

Today SWIM had a doctors appt and SWIM was doubtful that he would recieve and meds that would help him with his anxieity. SWIM's doctor started talking about Paxil, and SWIM's mom sugguested something short term like Clazopam. The dotcor was talking for like 5 minutes about how benzos arent the way to go, and how they cause drowsiness and stuff like that. Then to SWIM's suprise he was handed a script of Paxil 20mg, along with 30 .5mg Lorazepam. The Paxil is to be taken in the morning, and the Lorazepam is to be taken 1-2 at night and 1 in the morning if needed. Hopefully this will be a big help to SWIM and will end his anxieity.

What would be perscribed if the Lorazepam didnt work? Would they move SWIM to something like Diazepam, or Alprazolam (SWIM's doctors talk very negative about Xanax). Or would they up the Lorazepam?

Thanks for reading SWIM's story

[Alicia]

any good doctor would not put anyone on a long term benzo, over in the uk they are only really used and in the mental health department for controlling psychotics or other people who need to be kept quiet. they do use Lorazepam and can say that would help you sleep.

[Psych0naut]

First of all, lorazepam, alprazolam and diazepam are all predominantly anxiolytic benzodiazepines, not hypnotic benzodiazepines. You'll need a bit higher dose than an equivalent dose of hypnotic benzodiazepines to help you fall asleep or stay asleep. Second of all, benzodiazepines only make things worse when used for even more than a week, or a few days in case of hypnotic benzo's.

I have had a nasty physical benzo addiction after being prescribed Rohypnol(flunitrazepam) 1 to 2mg a night, together with Dormicum(midazolam) 15mg, as needed. I was on them for one and a half to two months, which caused a nasty addiction. That was only because I took them as prescribed, I did not abuse them. I had to go on a Lbrium(chloordiazepoxide) tapering schedule of two and a half months, and was switched to other, non-addictive sleepaids.

The non-addictive sleepaids I was prescribed, and still am prescribed are Remeron(mirtazapine) and Risperdal(risperidon). The former is a tetracyclic anti-depressant and the latter is one of the new anti-psychotics. I take 7,5mg mirtazapine a night, which is half of the lowest dose it's prescribed in for depression. In such low doses it doesn't have anti-depressant effects, but anti-histaminic properties instead, with one of the effects being sedation. It's already a very sedating hypnotic on itself, but combined with risperidon, which is also an effective sleepaid in low doses, without having much if any anti-psychotic effects. Many people are biased about it as a sleepaid, saying it makes you feel like a zombie even in low doses, but I strongly disagree with that, and I don't suffer from a psychosis or schizophrenia, but it does help me sleep. Those two drugs can be very effective for long-term treatment of insomnia, without the nast side-effects you get from benzodiazepines during long-term use, such as tolerance and addiction.

If I were you, I would try out those drugs, at least Remeron(mirtazapine), which is available as specially formulated sub-lingual tablets, which even taste like candy! If you really have persistent insomnia, adding risperidon to the mix will certainly help you fall asleep.

[laws0n]

SWIM's problem used to be sleep, then social anxieity. Nevrousness in class, which worsened and worsened every day. SWIM had a small perscription of Eszopiclone (Lunesta), that didn't work even for sleep let alone anxieity. SWIM's friend let him try a couple of Zolpediam (Ambien CR). It made SWIM tired but did not give him a good night sleep, SWIM kept having anxieity.

Alicia, SWIM is suprised that they are rarely used in the UK. SWIM has friends without the anxieity that SWIM has and just walk in and ask for Xanax (Alprazolam) and get it or something similar and just make up that they get panic attacks also.

As far as the addictive nature goes SWIM's mom was pushing for Clanazepam because SWIH used to have it prescribed and SWIH said there was only a slight effect that calmed SWIH down enough to get to sleep. SWIH was also perscribed Xanax (Alprazolam) and said it wasnt as extreme as long as SWIH took only as many as the doctor told her too.

SWIM has been going through ALOT in his life, parents divorcing, moved last year, grandfather's death, friends in jail, girls ect. Its only been 2 days but SWIM is getting ALOT better sleep, and is not as nervous in school, dosent avoid things as much as he did. SWIM has tried everything else before coming to benzos and SWIM and his doctor feels that it will do more good than bad. I see alot of people on this forum are against them? is this if recreationally used? or even if SWIM only takes how much he is supossed to?

[Alicia]

Originally Posted by laws0n

Alicia, SWIM is suprised that they are rarely used in the UK. SWIM has friends without the anxieity that SWIM has and just walk in and ask for Xanax (Alprazolam) and get it or something similar and just make up that they get panic attacks also.

this not regarding abuse of benzo's, there be other lighter benzos prescribed for things, but they dont give them out like sweets as ive seen in other places.

[Psych0naut]

Originally Posted by laws0n

I see alot of people on this forum are against them? is this if recreationally used? or even if SWIM only takes how much he is supossed to?

Both. Both recreational and medical use has led many people to an addiction, myself included. I'm very responsible regarding medication, I had a prescription for Normison(temazepam) which was later replaced by a prescription for Rohypnol(flunitrazepam) and Dormicum(midazolam). I took both for well over a month daily, up to one and a half months, and the Rohypnol started to loose it's effects in a week or so, and had little to no effects after 2 weeks. The Dormicum made my tolerance skyrocket like Apollo 3, it double with each day of use. That relatively short period of medical use of those 2 hypnotics gave me a bitch of an addiction, which I still have to suffer the consequences off. I'm still taking Librium(chloordiazepoxide) on a tapering schedule, together with Risperdal(risperidon) and Remeron(mirtazapine) to help me sleep, because I still can't sleep like a normal person due to desensitized, down-regulated GABA-bz receptors. It's been 4,5 months since I started on those hypnotic benzo's, and from the beginning I knew I was going to be stuck with a lot of problems, but at the time I wanted to sleep so desperately that I saw any following addiction as secundary misery. If only I knew then what I know now, that there are perfect non-addictive substitutes for benzodiazepines which work just as effectively, or even better. Unfortunenately I don't know much about any anxiolytic substitutes for benzo's, but I do know that there are plenty of better substitutes for hypnotic benzo's.

I'm shure there are plenty of other people on D-F who had their fair share of misery with benzo's, cause I've read addiction stories of other here on D-F on many occasions as well. The fact that they are often handed out like candy, and for long term treatment won't help to solve the problem of benzo addiction either, rather the opposite. Fortunenanely in some countries the goverments have realised the problems there widespread use has caused, and have tigthened prescription regulations for them, at least in the Netherlands and Great-Brittain, the goverment has noticed the problems their over prescribing has caused, and they have tightented regulations for them. I may take a long while in other places though, as some goverments seem to be weary of putting a halt to the prescription of addictive medication, due to financial interests(read, the pharmaceutical industry's lobby).

[laws0n]

SWIM has had to go see his regular doctor, get a counsler, see a phycologist, and a psycitrist. It was in no way like getting candy. The doctor however said it could be used for long term use,which kinda scares me after reading how fast your tolorance goes up.

What would SWIY do if you were SWIM? Benzos have been the only legal way that SWIM is able to get a good night sleep and cure his anxieity.

[Solinari]

It is pretty well accepted that any benzodiazepine including lorazepam will begin to lose its effectiveness over time and will require steadily higher doses to achieve the same effect.

I am a bit confused as to why the doctor would spend 5 minutes talking about how benzo's are not the way to go, yet start prescribing lorazepam anyway, seems very odd, surely they know lorazepam is among the older benzodiazpines (1971 apparently) and according to Wikipedia it has "a relatively high addiction potential", presumably relative to other benzodiazepines.

As for Mirtazapine, it does work, i get it myself although it was prescribed for depression i often take about 15mg (as opposed to the full 30mg) when i have difficulty sleeping. I also get 20mg of temazepam to take at night, but i don't take them every night, instead i take 2 or sometimes even 3 when i just can't sleep (one at any one time though) then go without for a couple of days. It's not ideal but it seems to work for me. The Mirtazapine, hah, i wouldn't exactly call it candy, but it does have an orange taste added to it, it's more of an (looks at pack) "orodispersible" tablet that is suppose to "disintegrate" on contact with the tongue, it doesn't quite work like that for me. Since we are on the subject, i have got the generic version before (i usually get the Zispin brand) which are smaller and seem to disintegrate faster, still not very tasty, i don't like to savour the flavour. Mirtazapine for me causes very vivid dreams and has caused me to gain more weight than i would have liked.

[frankz81]

i too take mirtazepine, half or one 30mg tablet for sleep also...
i too have gained weight, about 10kgs in the 2 months i have been taking it...

i used to take lots of nitrazepam and diazepam for sleep, but would mostly wake up in the middle of the night needing more as the valium didnt last too long.

does anyone know of something similar and as effective as mirtazepine for sleep but without the side effect of wanting to eat all the frickin time, this weight is really bugging the shit outta me!

[fiveleggedrat]

Swim hates how he can't even manage to see a doctor and get something even mild.

Swim is envious of those who can get things prescribed, Swim deals with neuropathic pain, anxiety/panic, and severe insomnia/bizarre sleeping habits, yet can get nothing to help him. Swim self-medicates with marijuana and tramadol that is not prescribed to him.

[staples]

The fact that he still prescribed Paxil and was reluctant about benzos suggests to me that he means to prescribe the Lorazepam only for 1-3 months until he starts seeing Paxil's anxiolytic effects. Then he should start tapering the Lorazepam...

But look, listen to your doctor and he'll listen to you. If you feel you are becoming dependent on Lorazepam or it's just not working too well, tell him you are concerned about this and he will help you. It seems backwards for your mother to step into the doctor's office and tell the doctor what you need...

Benzos are sometimes prescribed longterm for panic disorder (I've been prescribed to Lorazepam for over 2 years now?), and it works just fine at .5 mg doses as needed.

I used to get 30x0.5mg Lorazepam per month but I asked my doctor to decrease it to 10/month because I attributed a general feeling of being unhealthy to taking Lorazepam every day. 0.5 mg is still effective for me when I need it and, with several exceptions, I've not even needed to take half of my monthly prescription most months of this year. When it comes to anxiety (especially panic disorder), just knowing Lorazepam is readily available is therapeutic.

Of course, I'm not saying you won't get addicted or have any of the above-mentioned issues; I suppose I may be considered lucky that I'm not addicted to Lorazepam, but what I'm saying is that your doctor isn't interested in creating these problems for you (he didn't even want to resort to benzos in the first place), but he is there to help you with them if you need help.

Reputation Comments on this post:

for this and many of your other thoughtful / helpful posts

[GreatWonder]

Originally Posted by Solinari

As for Mirtazapine, it does work, i get it myself although it was prescribed for depression i often take about 15mg (as opposed to the full 30mg) when i have difficulty sleeping. I also get 20mg of temazepam to take at night, but i don't take them every night, instead i take 2 or sometimes even 3 when i just can't sleep (one at any one time though) then go without for a couple of days. It's not ideal but it seems to work for me. The Mirtazapine, hah, i wouldn't exactly call it candy, but it does have an orange taste added to it, it's more of an (looks at pack) "orodispersible" tablet that is suppose to "disintegrate" on contact with the tongue, it doesn't quite work like that for me. Since we are on the subject, i have got the generic version before (i usually get the Zispin brand) which are smaller and seem to disintegrate faster, still not very tasty, i don't like to savour the flavour. Mirtazapine for me causes very vivid dreams and has caused me to gain more weight than i would have liked.

SWIG has been on Mirtzapine for around 2 months, he was started on the orodispersible tablets (which tasted somewhat like orange sherbet) at 15mg and is now on 30mg. The 15mg did trigger some very vivid dreams where SWIG would wake himself up from talking in these dreams. The 30mg still have a slight sedating effect and on occasional mornings SWIG would stay in bed with no energy and had to force himself up to do stuff. Weight gain has been slight but SWIG thinks this was possibly caused by overeating and lack of exercise which he's now addressing!

On the subject of the thread, SWIG feels that since events which led to this med, SWIG has developed a much better relationship with his doctor. SWIG's GP sent him on his way with 56 temazepam on 1 script, a couple of dozen Zopiclone another time and regular handfuls of diazepam. SWIG knows some may doubt the doc's duty of care with these amounts, though the symptoms presented in order to be given the trust with these drugs were severe. Anyways SWIG is happy to report he's only on the Mirtazapines now, it was just nice to feel 'trusted' to be given the drugs - especially as SWIG came clean about his self-medicating and OP dealings.

[Politicalchalk]

Swim personally is a big opponent of the use of anti-psychotics for sleep, be it typical or atypical. Risperidone, quitiapine, etc etc can have some pretty wacky effects in people. Some people it works just fine for. Weight gain is a very common side effect, and long term use really ups the risk for Diabetes, esp. if there's a family history.

For sleep specifically, has swiY tried some of the more sedating anti-histamines? Some include hydroxyzine, diphenhydramine, and doxylamine. Swim's girl will sleep for days with the cheap, dollar-store diphenhydramine.

Benzos are a tricky subject. On one hand, they're invaluable for some people, but cause nasty, nasty addictions. As mentioned above, just knowing it's there in your med cabinet can be quite theraputic....the key is assess to yourself how badly you need to take a relaxant. Sounds like you've got some intense stressors to worry about.

A note on Hydroxyzine. It's an older antihistamine (with an incredibly large array of uses!) whose metabolite is all the rage these days...certizine. Anyways, hydroxyzine is used to treat anxiety, sleep problems, allergies, a weak analgesic in it's own right....but it's also used to help boost narcotics. The idea is that there's a synergy -- you can take a lower dose of the narcotic if combined with hydroxyzine. Swim personally finds it's helpful with benzos as well, not to mention sleep.

When you see your doc, at least ask about it. They don't use it AS much here in the states anymore, but it is still available, and generally speaking, very safe.