Lorazepam Dependence : a Case Report

Mr. G., a 38 year old married male fiom a urban middle socioeconomic nuclear family, employed as a bank officer, came to the Psychiatry Walk in clinic at National institute of Mental Health and Neurosciences with the complaint of not being able to discontinue taking lorazepam for one and a half years. There was no contributory family or any other past history. After a job transfer about 2 years ago, which entailed increased responsibilities, the patient had sought consultation for increased dreams. Three months prior to this he had been diagnosed as a hypertensive and started on antihypertensives and a diazepamimipramine combination. The dreams were mostly day residues and past memories and would result in a fitful sleep. For these complaints he was referred to a local psychiatrist who advised him to take tablet haloperidol 5 mg, which he later changed to tablet chlorpromazine 10 mg and tablet nitrazepam 10 mg, all at bed time. He reported improvement but discontinued medication in January next as he did not want to get into the habit of taking tablets regularly. For two months he was off drugs but still disturbed by his dreams. On consulting a general practitioner he was then advised to take lorazepam. Initially he strated with a dosage of 2mg at night with which his 3ymptoms improved completely. After about six months he found that he did not sleep well if he took only 2 mg, so he increased the dosage to 4 mg. He further observed that if he did not take lorazepam, he would experience initial insomnia, "inner tremulousness'and generalised aches and pains, specially in the shoulders. He also reported that 4 mg was no longer giving him the desired sleep. On examination there was no physical abnormality, nor was there any detectable psychopathology. The patient waj admitted for detoxification and all drugs were stopped. On the first day he slept for only two and a half hours and reported headache, shoulder pains and "inner tremulousness". The ileep increased to four and a half hours on the second day but he still complained of havhiess of the head. Thereafter he had only sleep disturbance for the next 8 days after which his sleep was of 8 hours, which was his premorbid level. No dreams