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Anyone have a benzo suddenly stop working?

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I know that people develop tolerance to benzos after a period of time, but I have maintained the same dose of Ativan (4 mg) for many years. I have been stable and doing well for me. I have periods of anxiety; they go up and then back down.


But starting last Monday, I just felt like something struck me out of the blue. There was nothing different going on in my life. No new stressors. No medication changes. I suddenly became extremely shaky. I never had any panic, but I described the feeling as "agitated" (although I'm not sure if that was the right word), maybe extremely edgy feeling in my brain is better. I completely lost my appetite. I would wake up shaky and instead of waiting to take my Ativan when I woke up normally, I'd have to take it in the middle of the night just to get by, but still couldn't fall back asleep. I've been sleeping 2-3 hours each night instead of my usual 7-8. I've lost 7 pounds in the last week. I attribute that to having no appetite (I have to force myself to eat), and I've also had unusually loose stools (not diahrea, but loose relative to what I normally have and a color change to yellow).


I would feel OKish if I frontloaded my doses of Ativan early in the day, but of course that left  me in a bind at the end of the day. I called my psychiatrist of 3 years all week and found out for the first time ever when I needed to call her that she doesn't "do phone calls." I would have to make an appointment but then found out she was out of the country at a conference.


Last night the shaking hadn't subsided and I felt like I had been in hell so I went to the ER. I told them all of this. It was a really bad experience. I think they forgot I was there. After a few hours a nurse finally came in and said the doctor was leaving for the evening and I'd have to see the night doctor. I told him what was going on, and said shouldn't we order some tests in the mean time? So he did some blood work.


Before the bloodwork came back, the doctor came in and wanted to put me on Abilify to calm me down. I told him I was already on Seroquel and that they're both second generation atypical antipsyhotics, and it seemed like an odd thing to add. He said he didn't know much about psychiatric pharmacology but thought that was a good one! He then asked me why I took such a small dose of Ativan! The whole reason I am addicted to Ativan is from doctors like him who think it's "benign" as he called it. He said a person of my size could be on up to 12 mg a day. I asked him if he realized that was a huge dose and he didn't think it was. I told him that for years i have been fine on this dose, and the reason I was there was to find out if something medically was wrong.


He left and eventually after prodding over and over I finally got the nurse to give me a print-out of the lab results, where they apparently just tested my CBC, electrolytes, and thyroid.


The doctor never listened to my stomach, ignored when I said about the lack of appetite, etc. For him it was all psychiatric before he even saw me. My dad was there with me and he laughed and said to him, "This is what the ER is like, you have a room like this that's 0 and the next one over's 100" (meaning that I was not an acute case). But it's very acute to me—I've worried I'll have to drop out of school if I don't feel better.


I researched more today and I did see that gastroenteritis (an upset stomach--which I seem to have) can cause reduced drug absorption, particularly for anticonvulsants and birth control. When I asked the doctor if there could be any reason my body was suddenly not absorbing the medication, he said there was no way to know.


I've been trying every relaxation technique I know. I've been doing all the things I had to do in the bad old days: meditations, hot milk, breathing exercises, but it just feels physically sick in my head nonstop. I can never let go and relax. And I know that not sleeping and eating well is compounding it.


Do you think I am grasping at straws when I try to explain it as not being anxiety and being instead from reduced absorption? I've been feeling so bad that I've been obessing all week about what it is. I also theorized that maybe I have some sudden cortisol production problem like a heochromocytoma or cushing’s because I've felt very, very speedy. My blood pressure and pulse have been high as well.


I've contacted my pharmacy to see if any changes were made to my drug, and it seems to be fine. 


Any ideas? Anyone else had this?

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Well it's rather hard to say for sure what's going on. That you been ok with ativans for 4 years indicates your use to what feelings you should have and what to expect. I can only speak from my own experience so please take it with a grain of salt as we are all different. For me the only two benzos that seem to react consistantly for me is is valium and klonopin. The others is rather unpredictable. And of course you could be building a tolerance too. Not sure how fast ativans is for that, but klons and valiums seem to be much more stable for me. I'm on xanax now and hate it.

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I just wanted to say I have had to deal with the ER like you did, and I sympathize with you.  When they only look at the psychiatric side of things, it feels (to me at least) like they are invalidating what you are feeling.  Can you see your GP on Monday?  Maybe s/he would take you more seriously that it might be something medical?


12 mg of Ativan seems to me like it would be a very high dose.  But I'm not a DR, so I'm not sure.  I just have never heard of that high of a dose ever before.


That sucks about your pdoc being out of the country and not doing the phone calls.  Is there someone on call for her?

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Thanks so much for both your responses. Yes, I contacted my GP and am going to try to see him this coming week. Didn't sound like anyone is on call for my psych. I speak to the secretary when I call, and it sounds like they just have a policy of doing nothing over the phone. Part of the problem is that she is quite a distance from me and I don't drive. I rely on my parens for a ride, so I have her scheduled at regular intervals and have never gone in as needed before, which would be difficult given my parents schedule and the distance.


I'm starting to feel a bit better (I hope—knock on wood). Starting to almost feel like this may have had some psychological roots I've started to identify with my separation anxiety disorder from my parents creeping back up. I can recall times many years ago where it seemed like no amount of benzo would help until I figured out what was bothering me. And very often it was separation anxiety. We'll see.


Thanks again.

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