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Dr_Anderson, Doctor
Category: Mental Health
Satisfied Customers: 335
Experience:  Psychiatrist
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URGENT FOR 6/27 DR ANDERSEN: only - Hi its margo HAVING SEVERE ISSUES TODAY with lorazapem.I was trembling–intermittently/ panic –It got hard to type.
WEBSITE HAS TROUBLE w/ me giving bonus. contacted tech support. will keep track and make sure it gets posted.
6/22 FRIDAY reduced one dosage of lorazapem./ switched to oral ATIVAN /& kept 1 LORAZAPEM pill – had SEVERE shaking when took first oral ATIVAN dosage.
6/21 SATURDAY- continued oral dosage- NO sleep that night
6/22 SUNDAY -from morning switched back to all LORAZ .pills, slept 4 hrs –
645am 125/113 p 93, dizzy, dehydrated, chills
6/25 MON– had sinus congestion – by night gone – slept TOTAL 6hrs-
6am 132/114 80 113/85/91 before 7ampill 1//7/84 p 74 10 to midnight woke up 127/92 p88 125/94 p76 4:45am shakes chills, strange dreams
112/88 p85, 5am-116/88 p78
6/26 TUES – woke up shaking, chills – had quick crying spells but by 1pm felt good
THEN STARTED THE PROBLEMS – LAST NIGHT ----panic-----11:45pm 134/102 p83,
1am 125/92 p62 AFTER PILL- SLEPT 4hrs -from 1am to 5:30am.
******6/27 WED- (today) – THE WORSE because they were ONGOING and CONSTANT symptoms--- hasn’t let up since 5:30am- shaking, panic attacks, nightmare, dizzy
FINALLY after 1pm pill – I had relief.. (It is 3pm).
Q- why the severity? My psychiatrist says he never had people with these withdrawal symptoms and intensity. He says quote-“ strange that you are having this intensity now.” He said call at 4pm if no relief and I should decide if I want to try some medication called Klonopin.
Q- He believes when I am in distress-- change medications.
After having bad time with ATIVAN , the last thing I need is more upheaval.
Its is 3pm and ok now. 1pm pill has kicked in.
Q- Please explain about Klonopin . You never recommended any drug change. I trust you the best. What do you attribute the severity which was ONGOING today with the symptom of PANIC/ trembling- being the primary ones. Will I have to battle them again the next few days?????
Q- obviously not comfortable to make another taper!
Q- are these bizarre symptoms like my psychiatrist thinks? You are the expert in this field.
5:30am – major SHAKING& trembling on and off ALL DAY ------125/96 p 86, 122/96 sp 80 sweat, bowel movement
7am – PANIC 128/114 p75 135/106 p75,
Lay down to rest 8am –
awoke 8:15am – PANIC---158/94 p89, 122/99 p76
9am 122/92 p62- PANIC
10:30am- DOZED 10 min then had nightmare
got light feeling & tired 116/87 p66
Noon ANXIOUS 121/85 p65
After 1pm pill- dehydrated.numb legs, chills
1:15pm 117/84 p 68 ---
********3:30pm – not having panic, just tightness in chest, chills………
T4 free .88 range .70-1.24
Tsh 2.41 range (.32-4.05)
T3 2.81 (ref range 2.4-4.2)
Dr_Anderson : Greetings!
Dr_Anderson : I am sorry to hear that you have had such a rough go of it this afternoon! I am not sure, to be honest, why they decided to become so severe so quickly, given that they seemed to be bad but predictable from yesterday. However, one theory I have is two-fold: (a) The switch back to pills from liquid was 3 days ago, so you are in the peak times of withdrawal symptoms, (b) The decrease in dose from 2 to 1.75 mg was within the past week, and so you are peaking with respect to withdrawal symptoms. No way to prove this, but of course it is a theory which happens to fit the facts.
Dr_Anderson : Regarding Klonopin, it is a long-acting benzodiazepine, with a longer half life than Ativan. It's half life is 8-12 hours, versus the 6-8 hours of Ativan. Switching to it is necessary in some patients to help alleviate withdrawal symptoms, because the effects of the Klnopin last longer. While my preference is to "dance with the one you came with," in this case the Ativan, in some of my patients I have to switch to another agent to taper them off, if the taper is hitting a brick wall because of withdrawal side effects.
Dr_Anderson : Given that you are in the peak days of withdrawal symptoms, I would have to speculate that it will continue like this, potentially for several more (3-5 days) before going away, although it may actually get better first in the next day or two.
Dr_Anderson : Every person is different, so every taper has to start with a common groundwork but get customized to the individuial. You are having legitimate anxiety and withdrawal symptoms, so whether it is common or not is not nearly as important as the fact that it is present, real, and distressing! BUT, the good news is, it won't last, as miserable as it is...
Dr_Anderson : Hang in there! I am happy to be of service, and I'm also glad your psychiatrist is "in the fight" alongside you to help you through this very rough time.
Dr_Anderson : Regards,
Dr_Anderson : Dr. Anderson

no sorry – facts weren’t clear ------I went
in 3 weeks down from 2.0 to 1.25mg Here is what happened

june5th -the decrease from 2 to 1.75 was started. (5days later)
psychiatrist said to taper

June 10 was next .25mg witdrawal. (then 7
days later)

22 - was another .25mg-

I am at 1.25mg NOT 1.75mg.

Now I was shaking and hard to type.. scared
to lose sleep and continue this pattern.

7pm dosage is coming up. It is the one I cut back.

Again current taper began on a Friday/ June 22. today is Wednesday June 27. If I stay
at this level will these effects- shaking continue like they did today the next
3 to 5 days It is obvious that this taper plan is too intense.
What to do? It was last night that
I became distressed then it spilled over to AM and afternoon until 1pm.

Note my dosage reduction this week happens at 7pm.

Please help me get on proper tapering

I went tafter ONE week from 1.50mg to 1.25mg. Seems that this was WAY TO DRASTIC including the switch to oral ATIVAN. Q- How should I proceed. I am ok one second then shake so bad can't type. Your help is greatly appreciated and most needed at this juncture

please check back because the IM is not working properly.

I don't trust my psychiatrist honestly. He knows I have drug sensitivities and the switch to ATIVAN should never had been made with a reduction. Also he has made many errors. I feel confident with you because everything you have advised on this site has been accurate and helpful. I need you to help drive this car even though we never met. I am hyper sensitive. I agree to stay with lorazapem - I just need clarification if this is where I should stay first and second obviously a better tapering plan involving longer time. One week doesn't feel enough now that I am at 1.25mg (if you think I should remain there- given my symptoms). Your help greatly needed at this time. from 5:30am to 2pm I was involved with panic attacks and shaking. Will this at least subside or be at same intensity going forward for next 3 to 5 can tell I am not in a good place. Margo


I just re read your email and see it will continue for that time.

Q- what intensity?

Dr_Anderson :

Ah, my mistake, 1.25, not 1.75, but the main concept is still the same: it is within a week of the dose change (knowing that the typical peak of symptoms can occur in 3-5 days, but for some patients can peak at the 7-10 mark - which it has for you). So, the severity of the withdrawal symptoms does fit with a pattern I have seen in some patients.

Dr_Anderson :

For now, I would definitely HOLD at your current doses. If you have another rotten day and night like the past couple have been, it might be worth going back UP by 0.25 mg, to be taken in the 4-8 hour window preceding when you worst withdrawal symptoms are.

Dr_Anderson :

I also think the taper needs to go slower for you. Since you want to stick with the Ativan and not go a different route, it means a slower taper on the Ativan is necessary (decrease every few weeks instead of once a week), but each dose decrease should be based upon the absence of significant withdrawal symptoms.

Dr_Anderson :

I'm sorry this is such a rough time, this last bit of Ativan is the hardest to get off of, but you are DOING it! Hang in there!

Dr_Anderson :


Dr_Anderson :

Dr. Anderson


Dr Andersen: Your help has been invaluable. I had deep sleep of total 4hrs yesterday not like the 4 hrs night before. Starting off less shaky. Sorry for all the rambling I was truly in an agonizing place yesterday. Now I am at 1.25mg with night dosages of .25mg at 7pm and .50mg at 1am.

questions: for the next cut- where- since I am at 4hrs. Q1,Do I wait to see if sleep improvement before changing the 1am. Q2- Do I leave the 1am and make reductions to either 7am/1pm/7pm

Dr_Anderson : Greetings! Well, for now, I'd advise no cut, just yet - let things settle a bit and get your bearings for the next couple days (although it is encouraging that you are starting to feel better around the time the next cut was planned). That all being said, for your next cut, when it occurs:
Dr_Anderson : (1) Yes, I'd get the sleep to improve a bit more. Restful sleep is good in general, but when dealing with anxiety and withdrawal, restful sleep is critical to restore your sense of hope in thjings getting better.
Dr_Anderson : (2) When that cut does occur, since you are every 4 hours, I'd try to space the medication so you are as evenly every 6 hours as possible. You are at 1.25 mg now, so the next dose will be 1 mg. So, option 1 would be to go to 0.25 mg every 6 hours. Option 2 would be to leave the spacing as it is but decrease the 0.5 mg dose to 0.25 mg. I prefer option 1 because it provides more even coverage for you, but ultimately the option you feel most comfortable with is the one to do! :)
Dr_Anderson : Regards,
Dr_Anderson : Dr. Anderson
Dr_Anderson : Greetings! It shows your name as having typed something, but my screen is not displaying it. Just in case you have a post sitting there for me to see! :)
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Thanks! It is still not showing your comment, though. :(
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