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Kate McCoy, M.Ed, NBCC, LPC
Kate McCoy, M.Ed, NBCC, LPC, Therapist
Category: Mental Health
Satisfied Customers: 5458
Experience:  Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
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Kate, Dr. H. lowered the Valium dose again Thursday from 5mg

Customer Question

Kate, Dr. H. lowered the Valium dose again Thursday from 5mg in a.m. to half. So now I'm down to 1/2 5mg three times daily. I felt really great Thursday but as each day has gone by I feel more tired and sleepy than the day before. Today I can barely keep my eyes open. This happens evey time I lower a dose. I'll call Dr. H tomorrow but do you have any idea why this happens? I would think I would feel more clear headed as each day goes by on the lower dose. Hernz doesn't think it's unusual. He seems to suggest that it only shows I need to lower another dose. You know how hard it is for me to get a direct answer from him. Can you explain what is going on? I know it has something to do with the longer half life but can't understand what that has to do with things.

Thanks,
Rita
Submitted: 2 years ago.
Category: Mental Health
Expert:  Kate McCoy, M.Ed, NBCC, LPC replied 2 years ago.

Hi Rita,

Valium does have a very long half life, the longest of the benzodiazepine drugs. That means that even though the drug is lowered in your system, the previous dose will stay in your system for a long while afterwards, from 40 to 100 hours. So you will still be feeling the side effects long afterwards.

Also, Valium causes other side effects besides sleepiness that may mimic sleepiness. For one, it causes severe sleep apnea. I know you have already addressed this issue separately, but the amount of medication in your system may override your treatment for sleep apnea.

Valium is also a muscle relaxant and a sedative. To be able to cause those effects, the medication would have to be strong. And your previous dose, 5 mg three times a day, is a large dose. It could be that since you were on such a high dose, the side effects are stronger than you realized before.

It could be that by the time you began lowering the dose, the medication was fully built up in your system. You may have felt great for Thursday, but the next day the effects were stronger because of the build up. And each time Dr. H lowers your dose, you expect to feel better only to notice that you don't because of the long half life.

It takes some time for the side effects to diminish each time Dr. H lowers the dosage. Because of the strong dose you were on and the intense side effects and the type of side effects Valium has, you may want to wait a week or so on the new dose to see if the side effects improve.

You may also want to talk to Dr H about the other side effects you might be having, like severe sleep apnea or sedation, to see if there is something that can be done to test you or counter the effects so you can be sure that you are not being affected in other ways.

Kate

Customer: replied 2 years ago.

Kate, now I'm really scared. Are you saying that each of the three doses of 2 1/2 I take today will stay in my system for almost two days even if I don't take more tomorrow?

Then when you add tomorrow's dose and the next day, etc. on top of what I already have in my system, it will take months for me to get rid of the stuff and feel normal again.

Kate, what do you mean by saying to have me tested. What kind of test are you talking about? And what could he possibly do to counter the sedation other than give me an upper?

Kate, I'm so scared right now. How long do I still have to go before I feel normal taking a total of 7 1/2 mg a day?

Rita

Customer: replied 2 years ago.

Kate, I was just thinking, is this a normal reaction for someone on started on this dose or is there something wrong with me?

Should I see another doctor for his opinion? I'm just asking for your opinion, nothing else.

Expert:  Kate McCoy, M.Ed, NBCC, LPC replied 2 years ago.

No, that is not what I am saying. What happens is that the dose levels off in your bloodstream and stays at that level unless you change it. But since Valium has a long half life, it stays at the previous level in your bloodstream for 40 to 100 hours. So if you take a lower dose tomorrow for example, the amount of Valium you are taking now will stay in your system for 40 to 100 hours at the same level. Then it would drop to the new level after that.

By testing I meant for the sleep apnea. It probably won't be needed but I was putting it out there in case Dr. H felt it was possibly a side effect you were experiencing.

I would give yourself at least a week on the new dose to see results. I don't know your metabolism or your overall health so that would be a guesstimate on my part. Dr. H would be able to give you a better idea.

It is normal for people to feel very sedated on Valium. It is doing what it is supposed to do since it is a sedative. Give your body time to adjust to the new level then you may not notice the side effects as much.

You could see another doctor if you want a second opinion. Even if it just brings you peace of mind, it is worth it.

Kate

Customer: replied 2 years ago.

He says my metabolism is very slow. If I read you correctly, if I should lower my dose and it gets too low and I get anxiety back again, that means he will have to raise it and after a day or a week my body/brain will adjust to the new dose and I won't experience the sedation, etc. Just like when I first started taking Xanax. I remember feeling sedated for quite some time and then it just went away and I felt normal. Is that what you are saying>?

I know if I call Hernz tomorrow he will likely make me wait until at least Wednesday before lowering the dose again. He'll ask me how bad my sedation is and other questions like can I drive, walk without falling, etc;, then tell me to wait another couple of days and call him back. If I get to the point where I am noticably slurring my words, then he will lower it.

I just wish he would have told me ahead of time that it might take a long time before we get to my theraputic dose.

Kate, just say that maybe what I'm taking now is my theraputic dose, as each day goes by will I feel more and more llike myself or does it always take 40 to 100 hrs to leave my system?

I know one of these days he's going to say he wants me to wait the full week to see if the dose is high enough to keep away the attacks.

Rita

Customer: replied 2 years ago.

Kate, I don't know if you got this or not:

Sunday, May 20, 2012 4:59 PM EST

He says my metabolism is very slow. If I read you correctly, if I should lower my dose and it gets too low and I get anxiety back again, that means he will have to raise it and after a day or a week my body/brain will adjust to the new dose and I won't experience the sedation, etc. Just like when I first started taking Xanax. I remember feeling sedated for quite some time and then it just went away and I felt normal. Is that what you are saying>?

I know if I call Hernz tomorrow he will likely make me wait until at least Wednesday before lowering the dose again. He'll ask me how bad my sedation is and other questions like can I drive, walk without falling, etc;, then tell me to wait another couple of days and call him back. If I get to the point where I am noticably slurring my words, then he will lower it.

I just wish he would have told me ahead of time that it might take a long time before we get to my theraputic dose.

Kate, just say that maybe what I'm taking now is my theraputic dose, as each day goes by will I feel more and more llike myself or does it always take 40 to 100 hrs to leave my system?

I know one of these days he's going to say he wants me to wait the full week to see if the dose is high enough to keep away the attacks.

Rita

Edit

Expert:  Kate McCoy, M.Ed, NBCC, LPC replied 2 years ago.

Rita,

 

Dr. H is probably lowering your dose slowly to see how you react. If he lowers it too much, you may have your symptoms come back. So a slow and steady decrease helps to balance having no anxiety symptoms and reduced side effects from the medications. That is probably why he is taking this so slowly.

 

Give this time. Your body needs to adjust before you consider lowering the medications again. See if you can practice your relaxation techniques, changing your thoughts (I will be ok, this will pass) and praying for answers. Lean on God to get you through. This will work out.

 

Good night, Rita. You are in my prayers.

 

Kate

Kate McCoy, M.Ed, NBCC, LPC, Therapist
Category: Mental Health
Satisfied Customers: 5458
Experience: Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
Kate McCoy, M.Ed, NBCC, LPC and other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.

Kate, he decided to lower my dose again after only 4 days because I was a little unsteady on my feet. He put me on 1/2 at a.m, and 1/2 at bedtime. Told me to wait until 5 days to call him to let him know how I'm doing.

I forgot to ask him what did it mean when it says it takes from 40 to 100 hours to wash out. What does "wash out" mean? And during that time, do you start to feel a little better or does it take until the wash out is complete before you feel the effects of the med being out of your system.

Why do they say 40 to 100 hours? Seems a big difference in time. Does that have to do with your metabolism?

If I'm going to get anxiety symptoms back will it be before the valium is completely out of my system or could it happen at any time?

I should have asked him these questions but he caught me just as I was coming in the door and my mind wasn't on the subject,

Thanks,

Rita

Expert:  Kate McCoy, M.Ed, NBCC, LPC replied 2 years ago.

Rita,

I hope the new dose helps alleviate some of your side effects.

Washing out is just a way of saying leaving your system. Because everyone is different, how long it takes for medication to leave your system depends on metabolism, overall health and other factors. So a wide range of time is given to help people to know what falls in the normal range.

You may start to feel better as the medication leaves your system. There will be less in your body, so your side effects should reduce.

The Valium won't be completely out of your system unless you stop taking it altogether. So if your anxiety does come back as you reduce your medications, the Valium that is still in your system will take the edge off. If you do begin to notice the anxiety coming back, the medication can be increased quickly.

Kate

Kate McCoy, M.Ed, NBCC, LPC, Therapist
Category: Mental Health
Satisfied Customers: 5458
Experience: Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
Kate McCoy, M.Ed, NBCC, LPC and other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.

Kate, here I am again with another question. I just realized that I keep asking about my sedation problem when it dawned on me that what I really want to know is how long the sedation lasts once I reach my theraputic level?

Say, for example, the small amount I'm on now is the right amount I need to keep my anxiety from returning. How long will it take for me to no longer feel sedated even though I'm still taking the same amount every day? Does there come a point in time that my body/brain receptors get used to this dose and I feel "normal" meaning alive and alert?

I have to admit I feel much less sedated today than I did yesterday. Because we've kept changing doses so often my body has never had a chance to get used to one dose for any length of time so I don't know what non-sedation feels like. I know when I first started Xanax I felt sedated for a long time and hated it but it went away. I forget how long it took but I do remember suddenly feeling great...happy, alert, and normal. Does valium work the same way?

Thanks,

Rita

Expert:  Kate McCoy, M.Ed, NBCC, LPC replied 2 years ago.
Rita,

It usually takes about 6 to 8 weeks for a person to get used to a medication. Because you have been lowering your dose, you may feel better sooner. But 6 to 8 weeks is the standard.

It is hard to realize that it may take that long. But you have already been on the medication for a while now, so the time should be shorter.

You also have to include factors such as how you would normally feel for that day. Some days you may be more tired than others, just as everyone feels. So on those days you may feel more sedation than usual. Eventually, though, you will feel as you did when you got used to the Xanax. It is just the wait that is hard.

Be sure you are eating well and getting enough rest. Both of those things factor in very much in how you feel.

Hang in there, Rita. God will take care of you.

Kate
Customer: replied 2 years ago.

Kate, hope you are enjoying yourself with your family today and just relaxing. I do not expect you to answer me today due to the holiday....tomorrow will be plenty of time.

I was just re-reading your above answer where you said it takes your body 6 to 8 weeks to get used to a new medication. I assume that means when the med you are taking is one consistant dose. Going up and down the way I have in such a short time have gotten the valium into my system but I think the constant changing only prolonged my system from settling down. I accept having the valium in my system already may help me feel better quicker but I think taking the same doseage every day for a matter of time is a big help to my slowly feeling better. And lets not forget the huge changess from xanax and effexor at the same time.

I think I have to accept that under the circumstances 6 to 8 weeks will probably be pretty normal. I am already having sort of good days and sort of bad days whereas a short time ago I was only having bad days.

My body must be getting used to the valium because in the last week since I started on the 1/2 dose a.m. and p.m. the sedation is a little better. Right now my instincts are telling me twice a day doses is the way to go for me and not going any lower right now.

I have a question that I hope you can answer....I've been on the twice a day dose of valium of 2mg. a.m. and p.m. for a little over a week. Do you think if this dose was too low for me that it would bring on anxiety or panic attack it would have happened by now or haven't I been taking it long enough to tell yet? I'm supposed to call Dr H. Wednesday and I can't wait to find out the answer. I confess it's like waiting for the other shoe to fall....is today the day I'm going to get an attack or not? Do I have to wait longer? You know what I mean. I am trying my best to relax with it all but it's there, lingering in my mind.

Thanks,

Rita

Expert:  Kate McCoy, M.Ed, NBCC, LPC replied 2 years ago.

Rita,

 

Most likely if you are feeling relatively calm right now but not too sedated, then this might be the right dose for you for now.

 

Having a panic attack comes from your thoughts. If you are determined to have an attack and really focus on it, then you might be able to experience some symptoms. But they are not going to be at the level of someone who is not on any medication or someone who is taking less medication, or a medication that doesn't work for them. The Valium is going to take the edge off any anxiety you may have. And since you have started at a higher dose then went down, you probably would have experienced any anxiety you were going to have by now.

I would give the medication some time to adjust in your system, but from what you have told me, you seem to be at a good level.

 

Let me know what the doctor says.

 

Have a wonderful holiday!

 

Kate

Customer: replied 2 years ago.

Kate, you said panic attacks come from your thoughts. I was told by Hernz years ago they come from your brain receptors (I think that's where he said) receiving wrong signals to produce adrenalin at the wrong time.

I know I've been anxious for a long time now but that happened when I started getting panic attacks out of no where. I trusted the xanax to keep my brain chemicals from receiving the wrong info, thus stopping the inaccurate flow of adrenalin.

I remember he said from my history that my brain was tuned to receiving wrong signals. I remember he said then and now that it wasn't my fault I was having panic attacks. He does say the anxiety is something I can learn to control but the panic attacks are different.

Now I'm all confused. I wish I had the right medical words to explain to you what he told me but I know he said panic disorder and anxiety attacks are two different things. That was 12 years ago. Has he changed his mind now (do they look at panic disorder differently now?)

Am I doing this to myself? Shouldn't I be taking meds? Twelve years ago we didn't have computers to look things up like we do now. The thinking was completely different. They used meds along with therapy but now all you read about is how bad meds are and how good therapy is to get rid of the attacks. Yet I don't know of one person who has gotten rid of either real anxiety or panic disorder without the help of meds.

I don't know what to believe any more.

Rita

Customer: replied 2 years ago.

Kate, I just found in my files the info Dr. H. gave me years ago. Here it is:

There are various causes for why a
panic or anxiety attack begins in the first place. Over a period of time, your
body's reaction to stress and excessive worry may be manifested in severe and
debilitating panic. If left untreated, this response by your body may become
habitual and uncontrollable.

Most modern research indicates that
anxiety attacks and panic attacks may be caused by a chemical imbalance in the
brain. When we experience feelings such as happiness, stress, fear, depression
or anxiety, the brain releases chemicals known as neurotransmitters. It is the
release and re-absorption of these neurotransmitters that affects how we feel.
People who experience anxiety and depression related disorders may have an
imbalance of the neurotransmitters serotonin, norepenephrine, GABA and dopamine.
There are medicines available that are designed to help 're-balance' the
release, reuptake and absorption of these key neurotransmitters.

It is important to note that in most
cases, one does not just experience a chemical imbalance disorder overnight. A
chemical imbalance is not the initial catalyst that leads to anxiety or panic
attacks. Conversely, there are triggers such as excessive worry, stress and
fearful situations that may lead you to experience an improper release of these
key neurotransmitters. Getting these triggers under control can help to provide
relief from these types of anxiety driven attacks. If left untreated more severe
and debilitating effects may develop.

Rita

Expert:  Kate McCoy, M.Ed, NBCC, LPC replied 2 years ago.
Rita,

I understand what Dr. Hernz is saying. But you are asking a medical doctor for information on a mental health condition. He is going to give you an answer from his perspective, which is going to be medically based.

This is an old debate that has been going on for years. It's akin to the chicken and the egg theory. But from a mental health perspective, chemical imbalances do not come to be on their own for no reason. They are triggered by trauma, and the thoughts related to trauma. It is no mistake that you have panic attacks and anxiety after surviving an extremely abusive childhood. Your thoughts were created in the environment you grew up in. Many people who are raised in abusive families have anxiety. It is a natural reaction. The thoughts then create the chemical imbalance Dr. Hernz described.

If anxiety and panic was just created by brain chemicals, then the population would be more evenly skewed with this diagnosis. And therapy, such as Cognitive Behavior therapy, would not work. Only medication would work. And at this point, most people do not find cures with medication. They can only treat the symptoms. However, therapy can provide a cure.

If you need an example of someone who got rid of anxiety and panic without medication, read Lucinda Bassett's book, from Panic to Power. I have also treated many people who did not use medication and worked on their anxiety and panic through therapy. Not that you are doing anything wrong by taking meds because everyone does it their own way.

Kate
Kate McCoy, M.Ed, NBCC, LPC, Therapist
Category: Mental Health
Satisfied Customers: 5458
Experience: Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
Kate McCoy, M.Ed, NBCC, LPC and other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.
Kate, I get what you are saying. For example, if I wanted my back healed by surgery, I would see a neurosurgeon. If I didn't want surgery but still wanted help I'd see an orthopedic doctor. In my case, since I can not only remember by first "panic attack" in my crib when I was taken away from my mother and was able to have the incident verified by the woman taking care of me, Dr H, felt I probably had a genetic type of chemical imbalance. There was also the fact that I never knew my father or anything about him other than his name. No medical history, nothing. The incident that happened to me when I had to take the two trolley cars alone at 5 years old to school every day that triggered a panic attack also factored into his diagnosis. I had many attacks all my life but never was treated. Now with everything I've read, I feel like I shouldn't be taking meds, that I should be able to handle it through therapy, that I'm making a big mistake. But there must be many people who are taking meds for this illness who I'm not hearing about. I don't know what I'm doing right now. I think I need to talk to another psych doctor for reassurace.
Expert:  Kate McCoy, M.Ed, NBCC, LPC replied 2 years ago.

Hi Rita,

 

JA is taking your new posts and putting them under the old thread. I have no idea what is going on. They haven't told me about any new policy. I have a question in with the moderators and I am hoping to hear back soon. I am sorry about this.

 

If you want, we can still keep working on this thread. Are you allowed to accept again on here? Some of the people I know do that, but I want to leave it up to you.

Again, I am sorry about this. I'll try to get it sorted as soon as I can.

 

Kate

Expert:  Kate McCoy, M.Ed, NBCC, LPC replied 2 years ago.

Hi Rita,

 

Sorry about the delay but I wanted to get the situation with the thread worked out before I spoke with you again. But it is still in limbo so I am just going to keep going on this thread, if that is ok with you.

 

It can be very confusing to figure out if there is a medical component to panic attacks and if that triggers atttacks or it is the other way around. You are going to get differing opinions about the cause from anyone you ask. But the main concern here is that you do what you feel works for you in your treatment. If you feel medication is your best option, then by all means follow that path. You can always change your treatment if you feel that trying therapy instead might help. Or you can do both. Some people choose to take medication to help until therapy becomes effective for them. It's all personal choice.

 

I hope that helps, Rita. If you are questioning your choices, maybe prayer is a good option. See what God tells you. He will open the right path for you.

 

Talk to you soon,


Kate

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