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Benzodiazepine paradoxical reactions

shibireru

Bluelighter
Joined
Dec 17, 2008
Messages
232
[I apologize for the length of this. I feel many of these details are necessary for a complete understanding of the problem.]

About a month ago I decided, as I stated elsewhere, that I would start taking diazepam regularly for my anxiety. I started at a dose of 5mg, was dissatisfied, and increased the dose to 10mg per day. About 12 days or so days into this treatment regimen, I woke up at 6:00 am with palpitations, tachycardia and feelings of profound terror and agitation, having taken the 10mg of diazepam earlier at 11:30 pm. I then foolishly risked the aggravation of my panicky state by taking more diazepam, but was fine, which suggests that it was a metabolite of diazepam that was causing the panic attacks. Fed up with this, I turned to 1mg of lorazepam BID, on consideration of the fact that lorazepam had worked so well in the past for me. I take this for a number of days and, while I feel a vague and transient increase in my anxiety each time the lorazepam begins to take effect, I otherwise and after that initial period experience a considerable remission of depression and anxiety to the extent that on one particular day I was able to look at a sunset and find it beautiful and watch a particular piece of media (I'll forbear to mention what) and feel emotionally aroused/moved. (It had been years and years since I had last done either of those!) This lasted only a few days and eventually the lorazepam starting making me feel extremely apathetic, depressed, and confused, and impaired both my short term and long-term memory - probably because it was interfering with my sleep architecture.

Later, I visit a psychiatrist at the behest of my mother. I explain to him my issues with sleep and divulge a bit of past history, as well as, giving him a laconic description of my present affective dysfunction, and he prescribes 60 temazepam 15mg QHS; 60 lorazepam 1mg BID; 30 depakote 250 mg QHS; and, finally, 30 trazodone 50mg QHS.

The first night, I took 50 mg of trazodone with 30 mg of temazepam as directed, omitting the depakote since my problem is not being too high but being too low. At first I begin to feel sleepy, but within minutes this sleepiness converts to a feeling of being wide awake and a bit anxious. Realizing that I would never get to sleep in this condition, I take half of a 15mg tablet of mirtazapine and wake up to feelings of profound confusion, grogginess, emptiness, depression, and a desire to just sleep the rest of the day away (which at this point was not going to happen, so I just anxiously paced around the house the rest of the day).

The next night, I combine just .5 mg of lorazepam with 30 mg of temazepam, and become increasingly anxious until I have a full blown panic attack. To remedy the panic attack, I take 4 or 5 mg of lorazepam; and while I continue to feel very anxious, I feel somnolent enough to sleep through the anxiety. I conclude that the temazepam is the issue, since it is a metabolite of diazepam which reaches considerable serum concentrations after about 6 hours, the amount of time it took on the aforementioned night for the anxiolysis of the diazepam to be transmogrified into the sheer terror which I experienced.

Next, I try another 7.5 mg of mirtazapine and 1 mg of lorazepam. I get apparently deep sleep, but I feel groggy and a bit anxious all day.

Last night, when the small amount of lorazepam I had taken earlier in the day had about reached its elimination half life, I took .5 mg of lorazepam and 1.5 grams of phenibut. My anxiety begins to increase and I attribute this to benzo withdrawal and so I take a milligram and wait an hour and my anxiety is only aggravated. At this point I reach the realization that I'm experiencing a paradoxical reaction and conclude that my only way out of it is to take a hefty dose of lorazepam (another 4 milligrams of lorazepam sublingually). After an hour or two, I find myself in a state of terror, helplessness, anxiety, agitation, but also sleepiness. I manage to fall asleep at about 3 am, despite being in a hellish state of mind.

(I should add that I take at least 3mg of melatonin and 500 mg of magnesium a half of a hour before bed every night and take roughly 400 mg of docosahexaenoic acid in the day. I've been taking the melatonin for so many years that it does nothing at all at this point, or so it seems.)

I have awoken today with a vague sense of inchoate hypomania. I'm feeling fully alert, agitated, somewhat in a good mood, and energetic, but at the same time a bit sleep-deprived, slightly confused with some difficultly composing my thoughts. I also have some fasciculation in my right eyelid that's been bothering me non-stop for some two weeks now.

So, there you go. I can't quit the lorazepam cold turkey, because I'll be a panicky mess, suffer severe insomnia, and develop in short time, I assume, with ever increasing sleep debt an episode of psychotic mania, and be sent to a psychiatric ward where they'll probably forcibly inject either ziprasidone, which causes me profoundly terrifying akathisia, or quetiapine, which caused me to have nightmares so horrific and dysphoric that I would experience panic attacks just thinking about them during the day and feared the dark and the feverish, hellish dreams that it presaged. And I can't continue to take the lorazepam because the same thing will likely happen with the exception that I might feel a bit less anxious or something.

Does anyone have any recommendations for me? Because I'm all out of ideas. If not then proceed to the following paragraphs.

[I have no ulterior motives in stating the following. i.e. I am not trying to coax slobberingly affectionate or commiserative attention out of anyone, and more still, I know by now that I would never get such a thing from anyone here anyways. Hopefully you will read the following as matter-of-fact, blunt, honest, unexaggerated statements of fact, and not would-be inducements to any emotional response, like sympathy, in anyone reading it, though you're free to experience such things if so inclined.]

I was thinking suicide would probably be my best bet on account of my life being in all probability unsalvageable and me having no real options left. I know that's what depressed people say, but I really have exhausted almost every possibility and I just can't seem to make any headway: I'm always numb, always bored, always lethargic, always lonely, always completely devoid of motivation to do anything of real value or importance, always anxious, always anhedonic, always pessimistic. Nothing moves me and I feel no love for nor attachment to anyone. Simply put: there is nothing of beauty or goodness in my life. At times it is bearable - when I am truly numb - but it's never good or basically enjoyable)

I have or will have soon all of the following:

60mg+ of lorazepam
120 mg of alprazolam
23.25 grams of phenibut
a few dozen grams of GABA
262.5 mg of hydrocodone + 17.5 grams of APAP (which I'll probably remove)
3 grams of pregabalin or 9 grams of gabapentin
45 mg or so of mirtazapine (trying to keep it low since it's a mild cyp2d6 inhibitor).
alcohol

I was thinking of grinding it all up in my mortar and injecting it rectally with a syringe, followed by the insertion of a butt plug of some sort (maybe the syringe?).

Do you think that would kill me and, if so, do you believe it would be acceptably peaceful?

Do you have any pharmacokinetic data on phenibut? I'm not sure whether it inhibits any liver enzymes or which it inhibits, if so.


P.S. I actually did learn how to unlock my dad's safe and am using his handgun as a back-up. (I really don't want to make a mess and traumatize anyone, but if I must...)
 
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I have tried all of the following in an attempt to alleviate my psychiatric problems, so believe me when I say I am pretty much out of options:

Sertraline
Paroxetine
Fluoxetine
Citalopram
Escitalopram
Mirtazapine
Nefazodone
Trazodone
Tianeptine
Duloxetine
Desvenlafaxine
Bupropion
Selegiline
Dextroamphetamine
Ziprasidone
Aripiprazole
Quetiapine
Pramipexole
Ropinirole
Cabergoline
Memantine
Lamotrigine
Pregabalin
Zolpidem
Zopiclone
Eszopiclone
Zaleplon
Lorazepam
Diazepam
Clonazepam
Hydrocodone
Oxycodone
Morphine
Fentanyl
Labetalol
Pindolol
Metoprolol
Clonidine
Doxazosin
Dehydroepiandrosterone
Testosterone
Letrozole
Docosahexaenoic acid
Eicosapentaenoic acid
Cytidine diphosphate choline
Alpha-glyceryl-phosphoryl choline
Dimethylaminoethanol
Phosphatidylcholine
Phosphatidylethanolamine
Phosphatidylserine
Phosphatidylinositol
Inositol
Vinpocetine
Uridine-5'-monophosphate
Creatine
Acetyl-l-carnitine
Carnosine
DL-phenylalanine
Tyrosine
Levodopa
Phenethylamine
Tryptophan
5-Hydroxytryptophan
Glycine
Taurine
Magnesium
Vitamin D
Multivitamins
Ashwagandha
Kava-kava
Rhodiola Rosea
St John's Wort
Ginkgo biloba
Ginseng
(I'm missing some no doubt)

I've even been desperate enough to turn to prayer - even though I am an atheist/antitheist and disgusted by all religious people - and to turn to Bluelight. I'm not sure which is more futile - prayer or asking Bluelight for help. /crappy joke


There are more anti-depressants out there of course out, but I am pretty fucking tired of this shit - trying a medication, enduring horrible side-effects, going through withdrawals and starting all over again.
 
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You need a more effective way to treat your depression. Also, there is a very good chance you'd survive your suicide cocktail. I'd go with Euthasol personally....

I've experienced paradoxical reactions from benzos, but it was from massive doses. It sounds like you are in benzo withdrawal.
 
ECT has gotten pretty sophisticated; it's nothing like it was in Ken Kesey's day. My employers have referred at least a dozen patients with treatment-resistant depression for ECT and I've only seen 2 of these patients relapse.
 
262.5 mg of hydrocodone + 17.5 grams of APAP (which I'll probably remove)

If you're going to use this coctail to kill yourself, why bother with removing the APAP? Dead men don't need a functional liver...
 
See if you can get an alternative drug with an off-label use as an anti-depressant. Such as buprenorphine or pregabalin to name a couple. Even maybe tramadol?
 
This is something I threw together in a few minutes. I'm sure it's very far from total accuracy, but it is accurate enough to give some insight into my condition I think:

http://imgur.com/toHLG.png

What disorder does this look like to you? And what drugs would effectively treat it?


seep said:
ECT has gotten pretty sophisticated; it's nothing like it was in Ken Kesey's day. My employers have referred at least a dozen patients with treatment-resistant depression for ECT and I've only seen 2 of these patients relapse.

I don't fancy that I am particularly intelligent, but I'd like to think that I were at least a few points above average. The thought of undergoing some infatuating treatment like electroconvulsive therapy or sodium-channel blocker therapy frightens me; either of those - particularly the former (and it would do so permanently I should add) - might be enough to push me over the edge into knuckle-dragging, tea-bagging, freeperland where people are only too happy to line up to imbibe their propaganda, where, as I write, there are lurching vomitous masses of corporealized dumb supplicating both their government and their invisible sky wizard that ruin be cast upon them and others, in the form of a corporatist theocracy that would leave the sick, poor, and hungry to languish in the gutter. I can't become the sort of person who, on the one hand, should wish that trillions should be spent killing hundreds of thousands of people and, on the other, should protest against the proposal that less money than was spent killing people be spent to bring an acceptable level of health to his fellow compatriots.

I live in a highly religious area (Utah) and have no choice about that. I fear that I would forget myself and succumb.

I forgot to mention that, as you can see from my above list, I have tried lamotrigine; it made me stupid as hell. I only used it for a shot time.
 
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If you're going to use this coctail to kill yourself, why bother with removing the APAP? Dead men don't need a functional liver...

Because that is enough APAP to cause hepatotoxicity and I don't want to die an agonizing death by liver failure over a period of weeks, if I should somehow survive the other drugs in the cocktail.

Drench said:
See if you can get an alternative drug with an off-label use as an anti-depressant. Such as buprenorphine or pregabalin to name a couple. Even maybe tramadol?

I actually signed up at a particular website to have doctors specializing in treating opioid dependency with buprenorphine in my area be notified that I was addicted to opioids and needed their services. A number of them contacted me through that website, but I just couldn't go through with it. That would be a felony, I believe, and someone like me really wouldn't survive in prison for too long (145 lbs. 5' 10''. Gay. etc...)

I tried pregabalin as that list shows.

I'll give tramadol a shot, if I can get it. I actually tried to get it from a few doctors but they either responded that it was addictive or that it lowered the seizure threshold. Both of which are true, but I don't care. They didn't seem to care that I didn't care.

negrogesic said:
I'd go with Euthasol personally....

I would, too. I'm not going to ask how to get it, though, on account of the BLUA sucking.
 
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Shibireru I think your problems go far beyond what taking a drug can solve. What therapists and the candy deals known as psychiatrists fail to mention is that ultimately the only person that can end your depression is yourself. All the drugs and therapy in the world are nothing more than a slight nudge in the right direction. This is the first thing you must realize, despite how powerless and hopeless you feel it is YOU who ultimately has the power to change.

With that said I think being a homosexual man in Utah can not be helping and I urge you to relocate at all costs. If you are at absolute rock bottom there then it can't get any worse by moving so take the first step to helping yourself and formulate a clear and decisive plan to leave the state for a more tolerant area. You will be amazed at what a drastic effect a change of scene can have on mental states.

Secondly you absolutely MUST get involved in some sort of athletic endeavor even if you don't fancy yourself as fit or competitive. Cardio is preferable but very hard lifting will also help improve your mental state. And for fucks sake please stop eating bullshit for every meal as I'm quit certain you do as it goes along with the package of depression. For some people the switch to a natural diet of whole foods is all that it takes (yes I am serious). Be particularly mindful to remove both caffeine and artificial sweetener from your diet. Things that have negligible effects on a healthy persons mind state can wreak havoc on the already damaged mental condition of a depressed person. Many little things add up to create excruciating states of hopelessness.

Third, and this is big, abstain from all psychoactive drugs. You are an intelligent person as I am sure you are well aware that depression stems from chemical imbalances. Taking drugs both therapeutic and recreational will likely only further your problems. With that said very moderate use of psychedelics may be greatly beneficial to you if approach in the right way. It did wonders for me and was the impetus for a change in perspective that snowballed into a permanent cure.

I myself suffered from excruciating suicidal depression for many many years (up to age 22) until I dropped the bullshit and took a practical approach including the things outlined above. Because ultimately thats all depression is: Bullshit. But when your face is buried in turds you cannot see through to the obvious truth to stop the pain. If you would like to discuss some honest solutions feel free to PM me, but only if you are serious about taking the reigns and changing your life for the better.
 
How could anyone prove that u r addicted to opaites or not? Doctors only care about the $$ y pay them for the visit. My doc never tested my urine or anything. All I said is I need suboxone, I was addicted and got my script. I think u make too big of a deal of going to prison for getting suboxone for something else. I seriously doubt that u would go to jail for it. But then again I don't want to advocate breaking the law no matter how trivial. If other opiates didn't help ur depression I doubt suboxone will. Tramadol has some AD properties and is easy to get as it is not scheduled.
 
What therapists and the candy deals known as psychiatrists fail to mention is that ultimately the only person that can end your depression is yourself.

It makes good sense from the perspective of evolutionary psychology, I think, to suppose that human beings have precious little to no conscious control over their emotional states. The pleasure that we feel when we eat something good for us is an incentive to continue to eat that food item. The pleasure that we feel when we have arranged circumstances in such a way as to best promote our survival is an incentive to continue to work to preserve those circumstances. If humans could completely bypass the natural world, which normally serves as a middleman in the interaction of the part of the brain that desires and the part of the brain where pleasure is created, we would never partake, I think, of those activities or food items which promote our survival and would die off. If I could simply will myself into a state of pure happiness, what need would I have for those things which promote the survival of my genes? In a state of pure happiness there is no anxiety or worry or fear and, thus, I wouldn't feel a compulsion to eat to preserve my perfect happiness.

Happiness, like it or not, is strongly dependent upon extraneous conditions or the vagaries of the chemical reactions that occur in the brain over which we have little conscious control. My circumstances - no - life, reality itself is in every way the exact opposite of what I desire and I don't think I can change that since there's no such thing as free will.

With that said I think being a homosexual man in Utah can not be helping and I urge you to relocate at all costs. If you are at absolute rock bottom there then it can't get any worse by moving so take the first step to helping yourself and formulate a clear and decisive plan to leave the state for a more tolerant area. You will be amazed at what a drastic effect a change of scene can have on mental states.

I've gone through all of this before, so here's the abbreviated version:

No car, ability to drive a car, driver's license, highschool diploma, GED, identification of any form, money beyond what I get from SSI, job, marketable skills, friends, or relatives outside of Utah. Moving isn't an option now and may never be.

Secondly you absolutely MUST get involved in some sort of athletic endeavor even if you don't fancy yourself as fit or competitive. Cardio is preferable but very hard lifting will also help improve your mental state.

I've been walking 30 minutes a day for the last couple of weeks and even though I find myself more depressed afterward, I've been keeping it up. How long does it take to feel better? So far it ain't workin'.

And for fucks sake please stop eating bullshit for every meal as I'm quit certain you do as it goes along with the package of depression. For some people the switch to a natural diet of whole foods is all that it takes (yes I am serious).

I eat chicken, fish, and turkey sandwhiches on good quality bread usually with mustard, lettuce, tomato, onions, and pickles, as well as margherita pizzas from a local bistro with basil, roma tomatoes, and high-quality cheeses. I take cyclooxygenase inhibitors afterwards to keep omega 6 fatty acid production low as well as docosahexaenoic acid.

I also eat a lot of fruits and vegetables that my dad brings me from his garden.

Is that so bad?

Be particularly mindful to remove both caffeine and artificial sweetener from your diet.

Not a problem. I get intermediate feelings of panic from a half of a can of coke. I haven't had any caffeine in ages. In total, I've probably ingested only a few grams of artificial sweeteners in my life.

Third, and this is big, abstain from all psychoactive drugs. You are an intelligent person as I am sure you are well aware that depression stems from chemical imbalances. Taking drugs both therapeutic and recreational will likely only further your problems. With that said very moderate use of psychedelics may be greatly beneficial to you if approach in the right way. It did wonders for me and was the impetus for a change in perspective that snowballed into a permanent cure.

I can certainly agree with this wholeheartedly.
 
Thats absolutely great to hear you are eating healthy and abstaining from drugs as much as possible. These are monumental steps towards getting better. Also great to hear you are beginning to exercise. The fact that you crash after physical activity is a good sign, it means its working. You are experiencing an endorphin rush while taking part in the activity. But I think you need to ramp things up a bit as 30 minutes of walking should hardly be considered exercise and burns probably less than 50 calories. But it is a start and that is what is important. Start to jog a bit more every day, start with say 10 minutes and increase it steadily as you are able. Make physical activity a priority in your life as it is something to look forward to because it is an amomplishment, a natural high, another piece of your puzzle, and something that will help you interact with others our age.

Also do not convince yourself you are unfit to partake in sports or that you can't find a way to get out and participate. Utah has some amazing outdoor activities so consider backpacking, climbing, or boating. All great sports for someone who does not give a fuck about dying, it will only make you better (I know from experience).

As for being stranded in your situation I can certainly understand your frustration. This is a major crux in your life, either do something crazy or end up dying. If that means buying a backpack and leaving everything you know then do it, if it means enrolling in a boarding school then by all means. A GED is a minor obstacle which I am sure you can overcome with the most minimal amount of preparation. This is a time you must become self reliant, I know this because I was also in an identical situation of being stranded amongst a family that did not accept me an no means to leave (being intelligent around fools does not help a mental state either).

As to free will that is your own philisophical take and you are entirely entitled to it. Personally I would tend to disagree at least in practice although you are likely correct that free will is non-existent. But in reality there are far too many minor contribuiting conditions in our lives to ever account for and some things in nature are truly random so while you may not be able to magically will your problems away you can certainly take the reigns and move yourself towards conditions that are more conducive to recovery.

Like I said I would be happy to talk at length via PM as I have gone through a nearly identical ordeal and somehow through luck and trial & error came out of it alive and with the knowledge to help others. I would be honored if you allowed me to try to help another weary wandered on this earth, and after all you have absolutely nothing to lose.
 
I'm happy when I sleep two hours a night. I know how you feel about caffeine.

If only they made a beverage that did the opposite... ;)
 
Could not agree more. Caffeine makes me a violent edgy dickhead. Cant wait to see if they are really going to promote that legal benzo beverage as an alcohol replacement in Russia.
 
OP: Mixing that many CNS depressants will probably kill you. Also, as 17.5g of APAP might not cause permanent damage, you would for sure have severe abdominal pain.
 
I have thought a long time about what to say to you, I am a queer guy, I escaped a country redneck area when I was 21, I still suffer from anxiety and depression at 31 but I am still here fighting on. What makes you think that your life should be so fucking easy anyway? You are talking about checking out before you have even checked in so to speak!
If you have purpose, your life has meaning. Your purpose will change continually throughout your life but when you are committed, it is a huge driving force that spurs you on.
At the moment why do you exist? Does your suffering have any meaning to it?
Your goal should be to get to a major city with a large gay population, wash dishs, pack shelves, find a boyfriend, break up suffer, find another, go through it again....I think that you get used to pain and it ceases to effect you so much and you develop an immunity to it. AND, if it doesn't work out you can always come back but you will be better for it. Drugs can lift you through the worst bits but the change needs to come from the experiences you give yourself.
I have suffered so much and continue to yet I have experienced a lot more life in my fruitless search for never ending happiness than many contented people I know who have sat on there hands and done nothing with there life because they are ...well, content.

Suffering drives you on, you need to move. At the moment your behaving like a junkie, much as I was. Your obviously a smart dude, many people in this thread have taken their time to help you, push through the pain, do what you want to do in spite of it, even if it ruins it, do it anyway.
Good luck
 
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