Benzos Extremely High Dose benzodiazepine PAWS (no taper) - Defeating the Beast

[Jktm]

I was prescribed 6mg of Alprazolam (2mg TID) and 4mg of Estazolam Q-HS for about 8 months (an equivalent of more than 80mg of diazepam daily). Following a couple suicide attempts in the beginning of this year, I was ripped off of them with no form of taper or even a phenobarbital detox. I got through the really rough acute detox, luckily without developing a seizure disorder, but now I'm in the infamous protracted benzodiazepine withdrawals. I rarely sleep (I probably average less than 2 hours per night when you factor in that I'm not sleeping every night); my pulse is constantly in a tachycardic state usually hovering around 120-130; my blood pressure is through the roof; I have perceptual disturbances; and I have occasional psychotic breaks with deluded thought patterns (and of course extreme anxiety and panic attacks, but I figured that went without saying). I'm about 3 weeks out of detox and my symptoms have been showing no signs of letting up.

To people that have come off of similar doses from a decent stent of dependence, I must ask, does it ever get better? Is there anything I can do? How do I continue my life? I have no clue what in the hell to do. I think the worst bit is the inability to sleep. I slept more when I was slamming methamphetamine, and I was doing a 1/3-1/2 a gram per shot.

 

[adder]

It can get very rough when you abruptly quit. I know what you mean with these psychotic breaks and delusions. I took BZDs for 9 years, I've been off for over 2 months now, and I'm pretty much fine getting better, but that was done with the taper. I jumped off probably at an equivalent to 10-15mg of clorazepate, that's a very very low dose compared to yours. 8 months isn't a terribly big amount of time, some say that for every year of benzodiazepine use you need one month to recover from PAWS, and generally the regular withdrawal lasts about 2 months. 3 weeks is too short to feel a great improvement, in my experience the first 2 weeks were the toughest, then another 4 weeks were transitions between feeling extremely bad and a bit better. I didn't experience much anxiety after 2 weeks, mostly it's that feeling weird, sensory hallucinations, derealization, depersonalization, feeling nostalgic which isn't always nice. Actually, it depends how you look at it and how hard other symptoms are, if I feel physically fine, then I'm using all this weird feeling to write some poetry etc.

You could try going back to a low dose of diazepam and taper down from that point, but if I were you, these 3 weeks would be a bit of waste for me. I think you should feel better in a month. Certainly your dose was too high to stop abruptly, but on the other hand 8 months isn't ages, and being on benzodiazepines daily has a terrible impact on your mood, so I think it's better to wait for your body to regain homoeostasis with time.

Alternatively, there are medications that don't act on GABA levels as benzodiazepines do, e.g. gabapentin or pregabalin, but still relieve anxiety to some extent. If you could get some professional help, then some sedating antidepressant could also do its job, perhaps it would be of greater value than any drugs acting on GABA levels if you're not extremely shaky. I sometimes used mianserin for insomnia, there's a newer analogue out there called mirtazapine. They're actually sedating antihistamines, so if you live where diphenhydramine is available, you might try this out too, but watch out with it and similar antihistamines that are also anticholinergics and they produce hallucinations at high enough doses. If you don't want to use those or can't, then you can look into some herbal remedies, e.g. valerian root or lemon balm, but you shouldn't expect some great effects of course.

Most importantly you should be able to get some sleep, so you get some energy. Sleeping less than 2 hours a night, you wouldn't be fine even without BZD withdrawal.

 

[Jktm]

I have some old prescriptions of trazodone and amitriptyline that I have been taking for sleep when I've gone too long without it, but I hate they way they make me feel (I'm having to take 300mg of trazodone and 200mg of amitriptyline to sleep). I've had mirtazapine in the past for insomnia, but it never really worked; I was having to take 60mg of ziprasidone with it and this was when I was taking 16mg of buprenorphine daily.

I guess I wasn't completely honest with my timeline. I was prescribed these doses 8 months ago, but before this I had been on and off of alprazolam at similar doses without a prescription for about a year before hand (long enough to develop dependence and detox), and I was on whatever random benzodiazepines I could find (usually alprazolam, diazepam, clonazepam, and lorazepam), taking usually an equivalent of 60-100mg of diazepam at a time, for about 6 months before I went to just alprazolam, but not taking them regularly enough to have incidences of dependence. How much do you think this might affect the duration of the protracted withdrawals?

 

[adder]

It's difficult to assess how much time exactly it will take. Like I've written, generally any withdrawal syndrome lasts 2 months, and the rest is pretty much personal. When you taper down, the withdrawal effects are less intense. So you could get back to a low dose of diazepam and go down from it. Any way you need to be ready for the negative withdrawal effects coming back even after months with varied intensity, but it should get better after 2 months. The bad effects come in waves, but the waves then tend to get weaker and weaker. And I'm sure keeping some healthy diet plays a big role in getting better, vitamins, neurotransmitter precursors etc.