Brief Answer:
Private Consultation

Detailed Answer:
Hello XXXXXXX and thank you so much for using my direct private service. I now consider you my private patient, and will do everything I can to be of complete service to you.

I do believe some of the symptoms you are describing are related to protracted benzodiazepine withdrawal. The fact that your shaking is improving with lorazepam is evidence of this, as lorazepam is also a benzodiazepine. It is likely that you need to be put back on Dalmane and then SLOWLY weaned off, rather than abruptly stopped. This might help with some symptoms of protracted withdrawal. How much lorazepam are you currently taking? It may be that your psychiatrist is replacing Dalmane with lorazepam which is a perfectly fine strategy.

Dr. Sheppe

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Brief Answer:
Followup

Detailed Answer:
If you are still having tremor, this dose may need to be increased to combat that.

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Brief Answer:
Followup

Detailed Answer:
It is not necessary that you be back on Dalmane. It is important, however, that you undergo a physical exam, and if the tremor is determined to be related to medication withdrawal, then your current dose of lorazepam, a benzodiazepine that adequately replaces Dalmane, may need to be increased temporarily, with the goal of being off Dalman and lorazepam permanently in the long-term.

You have two followup questions left in this thread, I would be happy to answer them!

Dr. Sheppe

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Brief Answer:
Private Followup

Detailed Answer:
The cause of your weight loss is also not yet clear to me. How much weight have you lost, in what time period? Has your diet or exercise changed? Have you had a recent physical exam? Bloodwork? We will figure this out.

If your shakiness is adequately controlled with lorazepam 2mg in the morning and 1mg at night, then this is good for now. If you are still not having shakiness after a week or so, you could try decreasing to 1.5mg in the morning and 1mg at night. I would not decrease faster than this, as it risks worsening withdrawal.

Please ask one more followup question here. Then, this thread will be complete, and you can rate/close it and open up a new one at my private link.

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Dr. Sheppe

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Brief Answer:
Private Followup

Detailed Answer:
I'm sorry the shakiness has returned. I would take the same amount of lorazepam, not more or less at this time. Your weight loss is indeed concerning and a cause needs to be found. I recommend seeing a primary care doctor for a basic physical exam and bloodwork to rule out big causes of weight loss.

If a physical exam and basic bloodwork are normal, and if your anxiety persists despite taking lorazepam, I recommend starting an antidepressant such as sertraline, escitalopram, or fluoxetine. Anxiety is treated definitively with antidepressants, not benzodiazepines (Dalmane, lorazepam). Anxiety may be the cause of both your tremor and weight loss, and may be effectively treated with an antidepressant.

This thread is done (4 followups), so please rate and close it, and then open up a new question thread at my private link. We can discuss things like starting a new antidepressant and how better to manage the tremor.

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Dr. Sheppe

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Brief Answer:
Private Followup

Detailed Answer:
As I mentioned, this thread is done (4 followups), so please rate and close it, and then open up a new question thread at my private link:

tinyurl.com/DrSheppeAnswers

I will briefly say here that your dose of sertraline is probably too low, as this can be given up to 200mg daily, so this will likely need to be increased. We can discuss this further in the next thread.

Dr. Sheppe

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