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Author Topic: Suggestions for therapy while abroad?  (Read 205 times)

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Offline mana

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Suggestions for therapy while abroad?
« on: January 30, 2014, 04:20:48 PM »
So, I believe I've been suffering from GAD for about a year and a half until I accepted I needed to go on medication (ativan/lorazepam) when it got so severe I was starting to experience physical reactions. A friend of mine who is a psychologist has told me I have anticipation anxiety, so I'm assuming it fall into this category? Like many on here, I've felt a lot of fear about taking medication (horror withdrawals, addiction etc.) but the alternative was... the same kind of symptoms? So, now I'm working on acceptance and trying to focus on the positive right now: that the medication works and is helping.

In a way I've seen it as a blessing as it's made me realise I need to care for myself more. I've started exercising again in a team situation, as loneliness wasn't helping, nor was sitting inside all day, though the language barrier is hard at times (I'm living in Spain but come from New Zealand), and I think such a big change was the mouse that sunk the ship. I've also been doing meditation and tapping exercises, and would like to slowly switch to doing all of these things without the medication, as I believe I can now that I know I have to listen to my body. However, there is no rush and I think I will wait until I return to New Zealand in August to start discussing this with my doctor and what's best for me.

I've been on the medication for about 6 weeks now and am grateful it is allowing me to enjoy my time abroad. However, one sticker is that I can't find or afford therapy and am relying on the help of a friend living in Portugal to give me a form of therapy via ***** at present. Certainly not ideal, but better than nothing.

I was just wondering if anyone else had been in a similar situation and could suggest some more techniques I could be doing to help myself? I would say someone to talk to online, but I already have that.

Any thoughts in general would be appreciated.
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"There will always be a part of me that is dirty and sloppy, but I like that, just like all the other parts of myself. I can forgive. Can you say the same for yourself, fucker? Can you forgive? Are you capable of that?"

Offline insights

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Re: Suggestions for therapy while abroad?
« Reply #1 on: January 30, 2014, 06:17:46 PM »
I was just wondering if anyone else had been in a similar situation and could suggest some more techniques I could be doing to help myself? I would say someone to talk to online, but I already have that.

The NZ Ministry of Health has an online CBT program called Beating the Blues®. As a NZ citizen I assume you can access it even if temporarily living OS. The sticking point is that your need to be referred by your GP. Are you able to contact him/her? Alternatively, the NZ embassy in Madrid may be able to help with this.

Are you taking Ativan every day, or only occasionally when the anxiety gets too severe?

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline mana

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Re: Suggestions for therapy while abroad?
« Reply #2 on: January 31, 2014, 04:01:46 AM »
The NZ Ministry of Health has an online CBT program called Beating the Blues®. As a NZ citizen I assume you can access it even if temporarily living OS. The sticking point is that your need to be referred by your GP. Are you able to contact him/her? Alternatively, the NZ embassy in Madrid may be able to help with this.

Are you taking Ativan every day, or only occasionally when the anxiety gets too severe?

Ian

Hi Ian

Thanks heaps for that, I never knew it existed. I could probably get someone back home to ask my GP to refer me. I'll have a poke around and see if it helps. It's not urgent at present, I don't think, but I'll see how I go with the link first before getting in touch with the embassy.

I am taking ativan every day - 1/2 mg around (Spanish lunch time) and 1 mg at night. I realise it's probably more of a use as needed type drug, but I am following the advice of doctor and psychologist friend until I return to New Zealand, as too many different opinions/suggestions will only confuse what is already a difficult time for me.
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"There will always be a part of me that is dirty and sloppy, but I like that, just like all the other parts of myself. I can forgive. Can you say the same for yourself, fucker? Can you forgive? Are you capable of that?"

Offline mana

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Re: Suggestions for therapy while abroad?
« Reply #3 on: January 31, 2014, 06:31:16 AM »
The NZ Ministry of Health has an online CBT program called Beating the Blues®. As a NZ citizen I assume you can access it even if temporarily living OS. The sticking point is that your need to be referred by your GP. Are you able to contact him/her? Alternatively, the NZ embassy in Madrid may be able to help with this.

Are you taking Ativan every day, or only occasionally when the anxiety gets too severe?

Ian

Hi Ian

Thanks heaps for that, I never knew it existed. I could probably get someone back home to ask my GP to refer me. I'll have a poke around and see if it helps. It's not urgent at present, I don't think, but I'll see how I go with the link first before getting in touch with the embassy.

I am taking ativan every day - 1/2 mg around (Spanish lunch time) and 1 mg at night. I realise it's probably more of a use as needed type drug, but I am following the advice of doctor and psychologist friend until I return to New Zealand, as too many different opinions/suggestions will only confuse what is already a difficult time for me.

Just to note, I am going to see my doctor again in a couple of weeks, at which stage I would have been on this kind of medication for about 2 months. I know it is possible to change to something a little bit more long acting, but then I assume I would still have to be on this medication during the time it took for this medication to work, at which stage I will be finished in Spain and going to travel Europe for a couple of months before returning home. Dealing with so much change is making it difficult, but I'm grateful to be enjoying what's happening here.

Basically, I would be taking this drug for around 8 months until I get home, and when voicing fears about that being too long on such a drug to my psychologist friend, she told me 8 months isn't a long time to be on this type of medication. Similarly, if I do need to change to a different medication, I would prefer this to happen in New Zealand.

I must admit all the horror talk about benzos has really freaked me out, though I'm dealing with it now, so any kind words would be welcome.
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"There will always be a part of me that is dirty and sloppy, but I like that, just like all the other parts of myself. I can forgive. Can you say the same for yourself, fucker? Can you forgive? Are you capable of that?"

Offline insights

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Re: Suggestions for therapy while abroad?
« Reply #4 on: January 31, 2014, 08:13:04 PM »
I must admit all the horror talk about benzos has really freaked me out, though I'm dealing with it now, so any kind words would be welcome.

The horror stories are, like most of the genre, often greatly overstated. Yes, you will be dependent on benzodiazepines (BZDs) after 8 months of daily use. You probably are already. Are you therefore destined to suffer greatly when you begin weaning off Ativan? Maybe....if you go too fast, or talk yourself into it. A number of studies have shown the mind can generate withdrawal symptoms when patients have been told their dose has been reduced even though it hadn't been.

It is a 'curious' fact that those with anxiety disorders tend to have much more difficult withdrawal experiences than those that have taken these meds for epilepsy. BZD withdrawal is not much of an issue in epilepsy forums. Yet, they take them in much higher doses than those normally prescribed for anxiety and often have done so for much longer. The average Klonopin (clonazepam) dose for epilepsy is about 10mg/day and 20mg/day is not unheard of. This is the equivalent of 20-40mg/day of Ativan (lorazepam).

Why do epileptics have fewer problems? Well it isn't because their brains are different. They have much the same BZD-GABA binding site deficits as we do. A more likely explanation is that neurologists are just better at weaning their patients off BZDs and do it more slowly and methodically. Another explanation is that epileptics don't necessarily have anxiety disorders so don't also have emotional/psychological 'baggage' to cope with when quitting. Many of the BZD withdrawal symptoms are typical of anxiety too.

When the time comes to quit the easiest way of doing it is to switch to diazepam (Valium) and wean of it. This has two major advantages over trying to quit on Ativan. Firstly, its half-life is much higher, up to 200 hours compared to about 15 for Ativan, which smooths out the peaks and troughs, especially at very low doses. Secondly, the equivalent dose is much higher while coming in relatively large sized, low dose tablets making weaning small dose reductions much easier. 1mg Ativan is about the equivalent of 10mg diazepam and the smallest dose 2mg tablets can easily be accurately quartered using a pill cutter so you can cut back the dose by 1/20th the starting dose with relative ease. You wouldn't be able to accurately divide a 0.5mg Ativan tablet into 10 pieces, though you could get the same result using Ativan liquid, albeit without the half-life advantage.

Using diazepam you should be able to comfortably reduce the dose by 2mg/day every month until you're down to 4mg/day, then 1mg/day each month down to 2mg and then in 0.5mg steps every month to zero. You could probably handle bigger dose reductions, but there are no prizes for doing it quickly. Also, because of the long diazepam half-life there is no advantage in dropping the dose at less than monthly intervals, but doing so may increase withdrawal symptoms.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline mana

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Re: Suggestions for therapy while abroad?
« Reply #5 on: February 01, 2014, 05:48:00 AM »
Hey again Ian

Thanks again for the information and the general tone of your message. I've found with some forums some of the advice looks like it makes the situation worse than better. I definitely won't be tapering off anything without the help of a doctor/medical professional when the time comes to do so, but am happy to see there are studies to suggest that half the problem in withdrawals comes from the mind, as I thought might be the case. Withdrawal symptoms and anxiety symptoms seem to look surprisingly similar. Who would have thought that would happen with someone struggling with anxiety?  :laugh3:

At the moment I suppose it is a 'trigger' I am working hard to overcome, but I must be easy and kind with myself. Like you say, if I go too fast and gear my mind up for the worst, well it will be no surprise if it happens. If I'm patient with myself and the treatment I can continue to get better.

I have asked someone back home to inquire about the link you sent me and have also sent an email off to the contact on the page. I've also spoken with someone I trust here, and it could be that I can receive the support I'm seeking from the counselor where I work.
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"There will always be a part of me that is dirty and sloppy, but I like that, just like all the other parts of myself. I can forgive. Can you say the same for yourself, fucker? Can you forgive? Are you capable of that?"

Offline insights

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Re: Suggestions for therapy while abroad?
« Reply #6 on: February 01, 2014, 06:44:34 AM »
Thanks again for the information and the general tone of your message.

Cool. We Aussies are used to having to save Kiwis from themselves. It seems to be our national burden. Heck, we even have to put up with what seems like half the population of NZ clogging up Bondi. And what thanks do we get, usually a right flogging at cricket, rugby and netball.  >:(

Quote
I've found with some forums some of the advice looks like it makes the situation worse than better.

Yes, the advise can be dubious, but the biggest problem with benzo withdrawal 'support' groups is the continual repetition of the symptoms which just reinforces the misery, essentially brainwashing participants into suffering far more than they otherwise might.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline mana

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Re: Suggestions for therapy while abroad?
« Reply #7 on: February 01, 2014, 01:50:33 PM »
Yes, I did notice a lot of the withdrawal symptoms to be similar to those of anxiety and thought maybe thete was some sort of connection there but very little actual support, just more fear
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"There will always be a part of me that is dirty and sloppy, but I like that, just like all the other parts of myself. I can forgive. Can you say the same for yourself, fucker? Can you forgive? Are you capable of that?"

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