Any ideas for a replacement for diazepam?

[EveHarrington]

That’s helpful @Sietz - thanks. I’ll look up lorazepam.

Probably a stupid question but: by the “high”, do you mean the chilled out, calm feeling?

Lorazepam and Diazepam are in the same family of benzodiazepines so it’s likely that your doc has a problem with the dependent nature of all the meds in this family. That is, I wouldn’t count on her switching you to lorazepam. They all have similar effects, it’s just that they have different half lives and stay in your system a different amount of time.

Your best best is to see a psychiatrist. My GP won’t prescribe psych drugs because they’re out of her league (and she knows it).

Gabapentin has like two official uses and like 25 off label uses. It’s used widely in the psych world for anxiety, I’m pretty sure off label. I take it for anxiety, I know people who take it IRL for anxiety, and I know there are many people here who take it for anxiety. It’s a good drug. It hasn’t given me sleep disturbances as it’s actually quite sedating for some.

There are also other classes of drugs that help with anxiety. I take a mood stabilizer that helps with anxiety, an antipsychotic that helps with anxiety, also lorazepam, and my antidepressant also helps with anxiety.

Do you have the option of seeing a psychiatrist? You med options will be much greater.

 

[barefoot]

Thanks @EveHarrington

Yes, I suspect my GP wouldn’t be happy simply switching to another benzo as his issue seemed to be around addiction...even though he can see I’ve had the same pattern of taking them for the past four years (ie no increase in me taking them, no signs of dependency issues etc)

I’m hoping the new GP will let me keep on as I am with the diazepam but I want to be a bit prepared with some other possible suggestions in case she isn’t.

The psychiatrist question is a timely one! I have never thought I needed to see one so it’s never really been on my radar. In fact, the whole idea makes me feel extremely nervous, for some reason.

But when I explained this situation to the sleep doctor recently, she looked like my GP was being a total pain in the arse and said she couldn’t see any reason why I shouldn’t be able to continue with the diazepam as I have been. She then said that she/the sleep clinic couldn’t prescribe it for me as it was not sleep-related. So she said if my GP isn’t helpful about it, the best thing would be to see a psychiatrist. The next thing is, she sends a letter to my GP updating him on the sleep stuff (mainly me starting Melatonin) and then she writes in that letter that my anxiety is currently high and that I may benefit from seeing a psychiatrist.

So...yeah...not really what I was expecting/wanting her to do...and not quite sure what - if anything - will happen about that if I don’t mention it to my GP.

I don’t actually know how easy it is to get a referral to a psychiatrist here through the NHS or whether I would have to pay privately. I know my therapist would refer me to a psychiatrist if I wanted to go the private route. I just honestly think I’d be wasting a psychiatrist’s time as I don’t think I need the meds enough to justify them meeting with me.

Re Gabapentin - I know it can be used off label but it seems it’s easier for hospitals to do that than GPs here - partly because GPs don’t necessarily know all the off label uses and partly because they tend to be more expensive options. Sleep doctor said they sometimes prescribe Pregabalin for people who suffer from anxiety re night time/falling asleep but that they don’t do that for people with parasomnias as Pregabalin increases the amount of time that you spend in the stage of sleep where parasomnias happen so increasing the time you spend there potentially increases their occurrence.

 

[Abstract]

Oh I think you would be best served seeing a psychiatrist. Its an NHS hangover that we should even hesitate. Brain chemistry is complex stuff.

So perhaps a beta blocker wouldn’t feel so different.

You are in position of them so why not give them a try? Preferably before your appointment. I have heard debate about this but they are often used as and when needed. Essentially they slow down all the overactivity in the body. Calming it. A lot of people find that helpful.

Your best best is to see a psychiatrist

Totally agree.

NHS

And herein lies the problem of course.

We can't expect a GP to understand brain medication fully. Especially if you are stating to talk about off license use and context of mental health stuff beyond a GP's expertise. The downside of the NHS trying to save money is that poor GP's are expected to be consultants for everything.

You never know, they may refer you. You could give it a shot. No insurance I assume. Good luck! I'm a phobic about anything "sedating" unfortunately.

Do you want to brainstorm what you are afraid for a pdoc?

 

[ILoveLife]

I don't know about Propranolol...
The beta-blocker I took you could either take constantly or as-needed.
Actors and musicians take them just for stage fright.
Uni students take them just for exams.

That's propranolol.
Shouldn't be taken continuously as it lowers bloodpressure too much.

 

[Abstract]

owers bloodpressure too muc

Oh, yup. Thats the one.

 

[RandyMac]

Benzo addiction happens and not the easiest thing to withdraw from.
I had quite a fight with it, 4-5 2mg Ativans a day kept the boogers away and 4-5 months to kick the habit.
I will never take psych meds again.

 

[Friday]

I take Valium about the same way you take Valium... and it seems with similar effect (no high, just me as me... other benzos can make me high as a kite, or knocked out sleeping, but Valium is just like instant-myself again).

The only direct substitute / equally effective (in a vastly different way) I’ve found for that is daily exercise to varying degrees, and certain synthetic opiates.

The “next best” from those 2 is about 3 miles thattaway... and that’s a pint at the pub, or a bourbon after -or at the start of- a hard day. Not getting drunk, and nowhere near a chemical reset, just a very very slight edge taken off / end put on the day. Which is only really effective when I’m either already doing daily exercise & pretty badass stress management, or so banged up (sick/injured) that I literally have zero other ways to blow off stress. It’s an incrediably pale substitute, and is less effective the more I drink. Meaning one drink? Works a bit. A tiny little bit of calm I don’t have to fight for / eases the pressure a smidge. 2 drinks? Works less. 3 drinks? Even less. And so forth.

These are all super addictive things, minus the exercise but I used exercise as self harm if I’m not paying attention, so I’m very careful with them. I’ve overused everything at some point or the other, so I’ve got a pretty clear idea of where my lines are.

 

[barefoot]

You are in position of them so why not give them a try? Preferably before your appointment.

Appointment is tomorrow and my anxiety has settled a lot now that Christmas is out of the way so I haven’t needed to take anything. So, I’m not going to just take one when I really don’t need one.

But anyway, the very common side effect of nightmares and sleep disturbances is very off-putting to me. I don’t think my GP should have prescribed me this one, when he knows that I’m receiving treatment from a sleep clinic (which he referred me to himself!) for night terrors etc.

I’m just starting melatonin treatment and am soon to start a CBT For Parasomnias course so, while I’m seeing whether those things are effective, I don’t see the point in taking something at the same time, which is potentially going to exacerbate my night time disturbances. I know that the propranolol may not give me nightmares and make me hallucinate/sleep walk etc as it doesn’t affect everyone the same way. But seeing as I already do those things and am seeking treatment for them, I think it’s counter-productive to use these medications together.
Also because I won’t be able to isolate each effect...if I take the propranolol and the melatonin and I continue to experience parasomnias, is that because the melatonin/CBT treatment hasn’t worked or because I’m getting an unwanted side effect from the propranolol?? (Though I’m aware that sleep disturbances can be a negative side effect of melatonin too - but so far so good on that front)

The sleep doctor I saw before Christmas thought my concerns were understandable and agreed that I steer clear of the propranolol. She suggested going back to GP to discuss staying on diazepam (or other alternatives if GP totally unwilling to prescribe diazepam again) and that’s when she said I may actually be better off seeing a psychiatrist.

We can't expect a GP to understand brain medication fully. Especially if you are stating to talk about off license use and context of mental health stuff beyond a GP's expertise. The downside of the NHS trying to save money is that poor GP's are expected to be consultants for everything.

Yes, I do get that...But I guess that’s where I then bump into my resistance about seeing a psychiatrist...!

No insurance I assume.

Alas, not anymore.

I’m sure my T would be able to recommend and put me in touch with someone who I could pay myself to see privately. I just have no idea how much that would cost and how often I would need to see them. So, I don’t know if that would be practically do-able or not.

Do you want to brainstorm what you are afraid for a pdoc?

Hmm...good question and I have been pondering this for a while, hence my delay in replying here...

I think I’ll start a new thread on this…thanks for the idea!

 

[MyWillow]

The brain melts? Wait...I think I’ve been doing it wrong! ?

When I take a Valium, I don’t feel a real high...I just feel much calmer and much more....unconcerned, I suppose.

Inner peace sounds good to me. Will do some research and may raise it with the new GP if she doesn’t want to prescribe more diazepam either.

Yes. That’s how it works for me. I use it when I feel frozen. And it takes the edge off just enough so I can get active and achieving or rest as the need arises. Sometimes I might take 2 doses in one day and other days I can use different coping mechanisms. My psydoc suggested I take it over Christmas every day and it was one of the easiest times I’ve had in YEARS. I actually had a nice time with my partner instead of fighting that horrible frozen feeling. She said it was a better option than retraumatising myself.

 

[barefoot]

Glad that your pdoc is supportive of you taking it, @MyWillow. And that it helped you to have a better time over Christmas this year - that’s great to hear! ?

 

[roaringrachel]

I take Hydroxyzine. I find it to work extremely well for me. It’s a cousin of Benadryl so it has that mild, calming effect. It’s mostly used for anxiety these days and most doctors are familiar with it. The other thing I like is that the dosage is very flexible. The average dosage of 25mg was too much for me, so I only take 10mg for a panic attack. It’s been a lifesaver!

 

[barefoot]

Thanks @roaringrachel Do you just take it as and when you need to?