Acute tension and agitation states
March 20, 2012 | 15,00 EUR | answered by Dr. med. Ralf Berg
Dear doctor,
I have been physically ill for a long time (thoughts of splitting, depression, etc.). Since January 2012, strong states of tension and excitement have occurred, sometimes accompanied by sweating, which I have also had years ago and even in my childhood and youth, which paralyze me internally and do not allow me to rest, I am paralyzed.
The states had subsided somewhat about 3 weeks ago, I had gradually stopped taking Lorazepam; now since March 13, 2012 nothing is working anymore, there is also a great pressure on the stomach to be felt, mental pain turns into physical pain. As I said, only 1 medication helps with all the mental agony = Lorazepam! However, before I take Lorazepam, I am overcome by a feeling of fear of possible dependence or withdrawal later on! Therefore, my questions:
1. How long (how many weeks/months) can I take Lorazepam, even as a long-term solution if nothing else helps? What is the daily maximum dose?
2. Does Lorazepam generally cause dependence in every person, or are there exceptions? Does Lorazepam eventually lose its effectiveness?
3. Can you urgently recommend another medication (neuroleptics) in high doses against extremely strong and aggressive states of tension and excitement, which does not cause dependence?
4. Can you recommend anything else in the field of psychology that I can do in my dire situation now?
Thank you in advance for your response!
P.S.: Unfortunately, I can only give 15€ as I am an early retiree, please understand, thank you!
Greetings
Dear Mr. Peter!
You are in an unenviable situation. I would like to start with question no 4, what else you can do. Due to the severity of your illness and anxiety states, and the fact of somatization, that as you describe your fears now manifest as physical misperceptions, as well as the fact that very strong and aggressive states of arousal occur, you MUST begin a competent and permanent treatment locally. In my opinion, this must include not only your primary care physician, but also co-treatment by a psychiatrist (who can prescribe you neuroleptics (question No 3), which I cannot and must not recommend to you without knowledge of the overall situation), possibly even outpatient or perhaps even short-term inpatient treatment at a center.
Regarding your questions 1-2: Lorazepam is not intended as a long-term medication. At most, it can be given long-term as an adjunct to psychotherapy or neuroleptic treatment, and only under control. You should not take Lorazepam alone for weeks.
Even though it is difficult, one must try to treat the cause of your fears and tension states. Please try to follow my advice and consult local therapists and doctors who specialize in such severe cases. The success rate is so low when trying to handle it on your own with self-medication that I cannot recommend it to you. Understand that it is like in other disciplines: a scrape can be treated on an outpatient basis by a primary care physician, larger flesh wounds must be initially treated in a hospital outpatient department, and complicated bone fractures must also be treated in the hospital. In my opinion, this also applies to your problems. Often, in an inpatient therapy program, one can more quickly determine what medication and psychotherapeutic methods can help you.
With best wishes for your recovery and many greetings
Dr. R. Berg
