Methods of last-result to treat harsh benzodiazepine withdrawal

[protoject]

i know it's a bit of a bump

I know this is quite a bump but I wanted to second the use of oxcarbazepine for benzo AND/OR alcohol withdrawal because this has been the most effective thing in my case. I highly recommend against switching to a different benzo or benzo type drug [i.e. phenibut, baclofen] as for me this created more problems. Not sure what my opinion is on tapering.. I know most people say that's the best thing to do but I just feel that I'm prolonging the problem personally

 

[negrogesic]

This is admittedly, an old thread, but I've long taken issue with the widely held notion that characterizes diazepam as, " one of the most euphorigenic benzodiazepines available". Such a characterization of 'valium' (being prevalent in both popular culture and medical literature), could be a consequence of the sheer volume of its prescription (particularly prior to the advent of 'shorter-acting' BZDs). The little 'blue pill' (10mg valium) has been prescribed so widely, that reports of abuse are similarly extensive.

As to ketamine during bzd withdrawal: Bad Idea. Yes, there are anecdotal reports of ketamine's potential use in opioid withdrawal, but in my personal experiences I found it of limited use (to avoid the unpleasant psychotomimetic effects, I administered the ketamine intravenously; a very dangerous practice).

As to pharmacological aids in the treatment of BZD withdrawal, high dose gabapentin has been used with some documented success, and pregabalin could hold promise. Both gabapentin and lyrica can produce discontinuation syndromes and should ideally be for a short period of time (acute withdrawal, during the inevitable X milligrams of BZD Y to zero. Valproate due to its toxicity and pharmacological limitations is less than ideal. Tegretol or better yet, trileptal, could be of use but possess their own issues respectively.......

 

[/navarone/]

I was given oxcarbazepine when I had my first seizures after my cold turkey clonazepam discontinuation. As an antiepileptic it worked well with close to no side effects but it had no anxiolitic value. Valproate is far better in that case but unfortunately it does put some pressure on you liver, plus other potential side effects. Considering that I was (and still am) a regular drinker, the precaution on hepatic impairment should have been higher, my doctor should have checked my liver condition before prescribing me 2 500mg pills a day, in fact after a few days I did notice some minor signs of dermatitis and some fatigue so I asked for a 500mg XR a day plus a change in my diet and alcohol intake. It worked out ok but obviously I still had some signs of anxiety which I just had to swallow and deal with it.
Unfortunately there aren't many safe alternatives around when speaking of mood stabilizers, each one seems to have it's downsides.

BTW
5-HT3 antagonists, 5-HT2c antagonists and 5-HT1a agonists have shown some remarkable properties in relieving anxiety and seizure propensity without much mental impairment, though I yet have to find a drug on the market that combines the 3 without other nasty (antipsychotic style) antagonist-agonist actions.

 

[negrogesic]

Mirtazapine has some of those features, and while sedating and initially dysphoric (for some), it is relatively devoid of the worrisome toxicities seen in dopaminergics (NMS, TD, etc). I've yet to personally come across a mirtazapine related complication other than complaints of sedation and weight-gain.

It is the only compound that i consistently take to this day (it is no longer sedating; i take it for the appetite stimulant properties). It's admittedly not the best anti-depressant (though in some cases, can be), but then again, i've never suffered from depression so my personal observations are of limited value in this regard....

 

[/navarone/]

Mirtazapine has some of those features, and while sedating and initially dysphoric (for some), it is relatively devoid of the worrisome toxicities seen in dopaminergics (NMS, TD, etc). I've yet to personally come across a mirtazapine related complication other than complaints of sedation and weight-gain.

It is the only compound that i consistently take to this day (it is no longer sedating; i take it for the appetite stimulant properties). It's admittedly not the best anti-depressant (though in some cases, can be), but then again, i've never suffered from depression so my personal observations are of limited value in this regard....

Yeah...I heard about its success and was recently unsure whether I should choose it over quetiapine for my next antidepressant therapy though I'm still dubious. It is also a 5-HT7 antagonist which has shown a decent axiolytic, antidepressant and even nootropic activity, the anticholinergic action ain't too high either and the alpha2 antagonism seems to improve 5-HT1 transmission in some parts of the brain. I'm waiting to see newer tetracyclics of the same 'shape' and see further improvement. Speaking of benzo withdrawal and seizure propensity, both mirtazapine and mianserin can cause seizures although rarely... I guess it's cause of it's weak mACh activity or maybe a cascade reaction from one of the alpha, what do you think?

BTW, based on your knowledge and experience, would you reccomend mirtazapine to someone suffering from mild depression, lethargy, anxiety, flat affect with also some signs of memory impairment and minor aphasia (broca style)?
The thing I most hate about my current state of mind and that depresses-worries me more whenever it worsens is thought and memory imparment, I frequently forget words, my expressive-linguistic abilities are sometimes much less fluent and elaborated even during longterm sobriety and this makes me feel so fucking uncomfortable. Mirtazapine's weak anticholinergic and antiadrenergic activity makes me frown a bit on this matter.

 

[negrogesic]

Hypothetically speaking, mirtazapine may have merits in your particular case, but there are a few concerns. If there has been a history of SI or attempts/self-harm, I would be concerned about the patients ability to cope with rather common complaint of initial dysphoria that can occur. I would be hesitant to suggest that you may realize any meaningful 'nootropic' benefit. I would also be curious as to the nature of your self-described abnormal affect, and any incidence of psychosis, etc....

And, mirtazapine is one of the antidepressants truly deserving of the notion that consistent dosing over weeks much be endured to realize the drugs potential. I am not a psychiatrist, but I do write a curious amount of scripts for the drug, as I am rather impressed by its relative safety and voluminous off-label uses (I have even written the drug as a short-term alternative to CIV hypnotics, albeit occasionally as a CYA attempt)......

 

[bluedolphin]

I went through in-patient benzodiazapine detox.

What pissed me off was that all they would give me was Carbamazapine... which is some poisonous and weird shit that made me pass out and feel incredibly sick... and Ativan once every 12 hours.

And this was for valium withdrawl so the ativan was like giving a coke addict a few hits of crack every 12 hours to withdraw. So stupid.

Anyway the best ways to get off benzos are with other benzos... especially Clonazepam it's probably the easiest to taper and quit and use very tiny doses to prevent seizure.

I would imagine Phenibut could help, not sure how well GABA-b helps out a GABA-a situation.

Kava barely does anything even in massive doses to help.

GABA does nothing.

Dilantin is a much better drug to prevent seizures than Carbamazapine, although possibly not as strong.


The most dangerous part of benzo WD is the seizures. I had a couple small seizures and a grand mal seizure even while I was on antiepileptics. I did not taper off my 70mg diazepam a day, though, I went cold turkey and checked in to detox 4 days later after I was hallucinating and had went insane from the withdrawls.

 

[/navarone/]

It's funny how many times I've heard about people treating benzo withdrawal with alcohol, and how many more times I've heard people treating alcohol withdrawal with benzos.
These two motherfuckers seem to get along quite fucking well...

 

[television82]

Just taken a truck load of diaz and xanax (well 50mg, 4mg respectively) in the last 2 days. This is after going cold turkey for 10 days beforehand to take a break. (I'd never taken either religiously beforehand. Just one or two every few days over about a year) I got through the 10 day break with no problems at all. Is this mini binge I've just had going to cause any problems if I go back into my break of abstinence?

 

[negrogesic]

I didn't quite understand the thread above, but from what I gathered I would have to strongly advise to not administer benzo's in any manner following BZD cessation (even in theoretically distant proximity). BZD's are notorious for precipitating WD in those who have experienced a discontinuation syndrome in the past, even if the BZD re-use occurs years later (apart from single, therapeutic dosing; acceptable examples being during an inpatient hospital stay or a 14 hour flight, etc).

 

[Solipsis]

Niacin with GABA is meant to increase permeability.

Yes this is picamilon, I've tried it and found it somewhat similar to phenibut perhaps but it felt more useful and medicinal without this chilled out feeling that brings some recreational / abuse potential. Phenibut completely kills social anxiety for me even more than other stronger sedatives, about on par with GHB. With picamilon it actually felt a bit hard to accurately say how well it could kill social anxiety because I had none when I did some trials. I have a lot of it lately and am also on benzo's. Not terribly high doses but frequent enough use to make me dependent. I think it's actually a pretty good idea for me to try and substitute my benzo use with picamilon and let you know how it goes. The main problem I am anticipating though, is that picamilon is hardly that sedative at all and can even feel like a very slight pick-me-up i.e. very subtly stimulating.

And FWIW, in the past I have combatted GHB withdrawal with pregabalin and gabapentin and they worked wonders for me. I've never been seriously dependent on GABAergics with extremely high doses from tolerance though and I hope I will never have to go through such hell.

Also the TT totally puzzled me, can someone edit it to 'last resort' ?