When to begin Ativan Tapering
Do not attempt Ativan tapering until you have stabilized sleep and anxiety. While this may sound counter-intuitive for some, there are ways to help stabilize sleep and anxiety before beginning your Ativan taper. Please review the Ativan alternatives page and discuss with your doctor whether some natural therapies can be put in place to help settle things out before tapering Ativan. If you are already constantly in panic mode, tapering Ativan might elevate such symptoms, resulting in an impasse. Get some help to bring severe adverse effects under control before attempting to taper.
Are your symptoms intermittent or are they constant?
Constant Anxiety
Is your anxiety constant and unrelenting? Is it something you always experience, because it is always strongly present? It may have gradually built up over a period of time but now it is constant. At Alternative to Meds Center we have found that most often, neurotoxic poisoning is the reason for this phenomenon. For instance, certain heavy metals drive anxiety, insomnia, ruminations, and other stimulatory symptoms. Mercury, lead, pesticides, and other accumulations can impact mental health in very real ways. Another example is Lyme disease, a medical condition that can present symptoms of panic as well as depression and others. Treatment for such a medical condition must be given priority before tapering can be initiated. Testing is an invaluable tool to help determine what toxic load your body may be carrying. Cleaning out these accumulated poisons will relieve constant anxiety symptoms where they are caused by neurotoxic poisoning.25-29
Intermittent Anxiety
Does your anxiety come and go? Some days it is there, and some days it is not? Perhaps mornings are fine, but as the day goes on it worsens? Are you okay in the summer but suffering in the colder months, or perhaps vice versa? On investigation, this intermittent anxiety may be related to one or more of the following factors.
Factors Linked With Intermittent Anxiety Include:
- Hormone imbalances 20
- Food or other allergies 21
- Seasonal changes 22
- EMF influences 23
- Concurrently taking SNRIs or other stimulants 10
- Adverse reactions between doses18
- Unresolved situational or workplace anxiety 24
- Blood sugar spikes and crashes (hypoglycemia, hyperglycemia) 16,17
You are invited to learn more about strategies to address these issues on our services page. Reactions that occur between doses are not uncommon and can be related to the speed of the taper. You may need to slow down your rate of reduction. Benzodiazepine tapering is an incrementally slow process.
Also, you can learn more about options for treatment on our medication tapering page. For example, your doctor may suggest staggering your dosage over the day so that your intermittent anxiety phenomena lessen. This could be important if such symptoms emerge during Ativan tapering. Sometimes these newly emerging symptoms are misinterpreted as “mental illness” or “relapse” when in fact they are vital signposts that can lead to a resolution if you are able to investigate their causes. Various methods of tapering are described on our medication tapering page that may be appropriate for your unique situation.
Research the topics of intermittent anxiety and constant anxiety, and discuss your concerns with your prescriber so you are both on the same page.
Gather support from those close to you
There are few things more painful than witnessing the suffering of others. Generally, people will want to help if you ask them. Tell the people close to you what you are planning, so they understand, and they are confident that you have good medical assistance to allay their concerns. It can be really hard on those around you to see you suffer. In fact, this is a valid reason so many people opt for inpatient treatment. Not only is it more productive and easier to endure, but it also relieves the stress and worries of those close to you.
A fascinating study authored by Pettinati et al published in the Psychiatry Quarterly reported that outpatient drug treatment was 4 times as likely to result in early treatment failures than inpatient treatment.30 However, if inpatient care is just not available to you, putting a strong support system in place may be instrumental to your success. For example, you might try showing some videos of the struggles of others who have gone through it. Peer support groups may also be available in your area — medication has become nearly endemic in today’s world, and there are many who have walked your path before you. In these ways, your family and friends can become more compassionate and understanding of your situation, and this can have a calming effect on their fears and concerns for your well-being.
Avoid stimulants in food and beverages
Avoid caffeine in coffee and energy drinks during your taper. Other stimulants to steer clear of include MSG, glutamate, and Aspartame©.
Caffeine can throw a wrench into the process of eliminating benzodiazepines from the system. In a review published in the Journal of Brain Research, authors Nehlig et al conclude that caffeine has obvious effects on anxiety and sleep, and suggests that caffeine enhances the release of dopamine, and may also affect serotonin neurons. The authors call for more research on the mechanics involved.31
Similar effects have been studied on the effects of excess glutamate from foods, especially those processed with flavor enhancers such as MSG, Aspartame©, and other chemicals. The body breaks down such chemicals in the process of digestion, and some of these can have significant stimulatory effects. Avoid them wherever possible to tip the scale in favor of your health recovery, especially while attempting to safely come off benzodiazepines.12-15
Balance blood sugar
Blood sugar can go too high, or too low. Both of these scenarios can induce psychiatric symptoms that have nothing to do with a psychiatric diagnosis.
Especially during coming off benzodiazepines, diet modification can be a potent tool for energy as well as balancing blood sugar. This can help to avoid unnecessary mood swings, dropping energy, or other mental and physical phenomena associated with blood sugar spikes and crashes.
Become informed on the symptoms of hyperglycemia and hypoglycemia so you can recognize them should they present.16,17
Exercise
Anxiety can feel like a sort of paralysis, leading to inactivity. You may find that gently easing into an exercise routine can help, though it may initially seem like an impossible task. A phenomenon called “anxiety sensitivity” has been studied, where a person becomes anxious about the physiological effects of exercise.6 Just the thought of exercise can increase feelings of anxiety and can cause a kind of resistance to any motion. However, with practice and self-compassion, the discomfort associated with exercise will become lessened over time.7 At Alternative to Meds, we offer trainer-led exercise sessions, that are designed for your current and increasing tolerance and ability levels.
If you are attempting Ativan tapering in an outpatient setting, you can still start implementing a very gentle, gradual, regular exercise regimen that will get your body moving. The range of benefits from exercise is vast, including protection against aging and memory loss, better sleep, improved appetite, and helping to gently detox certain organs in the body.8,9
Ask your prescriber for the lowest dose of your medication
You can ask your prescriber for the lowest available dosage of Ativan, which is 0.5mg, to more easily configure decreasing dosages along your taper. This will allow for the most exact totals. For example, to come down from 4mg to 3.75, a person can configure this dosage using 3 x 1mg tablet, and 2 x 0.5, plus cut 0.5 in half for the remaining 0.25 to make up the total of 3.75mg. This can greatly simplify the math involved.
Multiple medications
Are you taking multiple medications along with Ativan? Some of these may be driving anxiety or insomnia and can be eliminated first. Examples could be Provigil, SNRIs, or others that could have a stimulant effect. Your Ativan taper will go more smoothly if you can reduce or eliminate these medications first.10
On the other hand, if you are already taking drugs such as SSRIs, or mood stabilizers like Depakote or gabapentin, continuing these may assist the benzodiazepine taper. Your doctor may decide it’s better to stay on those until the Ativan taper is complete and you are stable. Otherwise, you may be left in a difficult position of having no support for tapering the benzo, which is more difficult to taper in comparison. Speak with your doctor about the most logical sequence in regard to reducing multiple medications.
IV Treatments for Ativan Tapering
Alternative to Meds Center offers a wide variety of therapies to assist with medication cessation. IV treatments have their place and can be extremely beneficial while tapering. For example, NAD+ IV therapy is one of our favorites, known for its significant benefits in easing the tapering process.
NAD+ IV therapy helps sleep, and mood, and supports the immune system, resulting in a treasure trove of benefits to overall health improvements and longevity. We have found it is tremendously useful during benzodiazepine and other medication cessation.11
Valium Crossover for Ativan tapering
In outpatient treatment, Valium crossover tapering is sometimes used where the Ativan tapering has reached an impasse, where even the smallest of cuts cannot be tolerated by the patient. You can read more about this and other methods of tapering that may be useful on our benzodiazepine tapering page. Share this information with your outpatient physician in case it should become useful during your treatment.
Ativan tapering and toxic responses (Lyme disease, toxic burden, etc.)
There may have been a response to the presence of certain toxins in the body. A medical situation such as Lyme disease can have similar responses that are debilitating. Where Ativan or other medications have been prescribed to dampen these symptoms, there is value in investigating elements of toxic load in the body, and taking steps to remove such toxins as part of an overall health recovery plan.
We have found that not doing so can result in Ativan tapering being much more difficult than it ever had to be. There are many factors that can be addressed in preventing or resolving protracted symptoms including genetic issues, liver and kidney health, and the presence of heavy metals or other toxins in the body. Addressing these factors can greatly simplify Ativan tapering.32
Half-life for Ativan ~12 hours 33
Tapering Ativan done too abruptly or without proper preparation, can result in reactions that may be impossible to endure.
Symptoms During Ativan Tapering can include:
- Return or worsening of anxiety
- Return or worsening of insomnia
- Panic attacks
- Agitation
- Heart palpitations
- Pain and stiffness
- Dizziness
- Sensory disturbances
- Seizures
- Psychosis
- Suicidal thinking
Monitor these symptoms closely, especially within 1 to 4 days after a reduction in dosage. Slowing the taper is recommended to avoid serious or lingering adverse reactions.33,34
Ativan tapering may be the most difficult at the end
Do not be dismayed if your Ativan taper becomes more difficult after the halfway point. This is not an uncommon occurrence. Stay well-coordinated with your prescriber so that smaller cuts and more time can be allotted to settle out at each new dosage. Do not be discouraged because it is going slower than you had hoped. When it comes to benzodiazepine cessation, “slow is fast” as the saying goes.
Ativan Alternatives and More Information on Ativan Cessation
Please feel free to review and share the pages on our site that specifically address holistic and alternative therapies that are useful during inpatient benzo tapering. Please see Ativan alternatives and Lorazepam cessation. Also, recommended reading is medication tapering strategies and the benzodiazepine cessation page.