Advice for short term user and direct taper

Hello,

  I am looking for some taper advice, and perhaps some people on the board who have not been taking benzodiazipines for years.  I started on Xanax, taking a short 20 day course of .25 mg. The first few days, I took the whole dose, but then, I would take a 1/2 dose, and then every other day or so, I would end up waking to take the other half, and some days I would just take the whole dose at once before bed if I felt more anxious than normal.  My Dr. prescribed me a second course of Xanax, for 30 days, and by this point, I was taking 1/2 and waking to anxiety and taking the 2nd half nearly every night.  The Dr. then switched me to Klonopin, .5 mg.  I still had about a week's worth of Xanax left, so I suppose I took the Xanax just over a month in total (about 40 days).  Most nights, I would take the full klonopin dose, as I needed it for sleep. The reason I was prescribed these medications initially, was due to insomnia and anxiety.  I took this course for a full 30 days (a few times, I cut in half and slept through the night).

I didn't think I needed to taper or anything like that because I had not been taking it for very long. However, I started to get anxiety about not being able to sleep.  Basically, I was taking the Kpin every night in fear that if I didn't, I would not sleep or the anxiety would kick in and I'd end up in panic.  But looking back, I now can see that I probably could have just taken this medication on an "as needed" basis and only when I truly couldn't sleep or manage anxiety symptoms.

I took the last 1/2 dose on a Thursday.  I slept Friday night w/out any medication and I slept fantastically.  However, on Saturday, I wasn't able to fall asleep, so I took 1/2 of a Xanax.  Woke up 4 hours later, and took the other half. I did this for 3 or 4 days, and then the Dr. switched me to Ambien, at a very very small dosage of 5 mg.  I would wake after 3 hours and take a second 5 mg, and this only went on a few days. I had a 20 day script and still have 15 of these left.

On day 10 after stopping the Kpin, I was determined not to take anything.  When I say anything, I mean ANYTHING - no benzos, no benedryl, absolutely nothing.  This catapulted me into high anxiety and zero sleep.  (I already was not sleeping well, if at all, on the Xanax or Ambien) By this time, I had started reading all of the horror stories about benzo withdrawal, and landed myself in the ER.  While in the ER, I experienced a level of anxiety i had never experienced before. I was sweating profusely, crying, shaking at times, felt like things were off spatially (like I was in a dream and couldn't wake up from it), eventually, I was nauseated and had diarrhea and gastric upset. I am still not sure if I was actually "withdrawing" or if I was anxious about withdrawing, but regardless, I spent 2 days in-patient, in search of support.  I felt this way all morning and onward into the day and evening, though, I also can appreciate that being admitted to an in-patient psych floor was also anxiety provoking and could have contributed to these experiences, too.

I was admitted on a Sunday afternoon, and re-instated on .25 mg Kpin, along with 7.5 mg of Remeron. I didn't take the Remeron the first night, as I was too scared to. I was afraid of adverse reaction or worsening of anxiety and insomnia.  I ended up able to sleep only after a dose of melatonin and 50 mg of Trazadone.

Monday morning,  I was advised to start a dose of Lyrica (I was previously on Gabapentin for nerve pain, so this drug didn't scare me too much).  I took my 2nd dose of .25 mg Kpin and a 7.5 mg dose of Remeron, and I slept extremely well.  I felt really good, but I was not a fan of how the Lyrica made me feel during the day, so i discontinued it. 

I was discharged Tuesday, with a taper plan of staying on .25 mg of Kpin for 1 week (or 2 if needed) and then another 1-2 weeks at .125 mg and then discontinue the Kpin, and stay on the Remeron.

It was suggested by my Dr.  that I could discontinue the Kpin, and take either the Lyrica or Gabapentin as a bridge medication.  I opted not to do this because there is so much literature on the internet that states that a taper is safer and I did not want to go back to the experience I was having when I went to the ER.

There is so much conflicting information and I am struggling to know what is best to do.  Much of the information is in regard to those who have been taking benzodiazapines for many years, and not alot of information for those who have only taken it a few months, such as my case.

The dilemma I am struggling with is "the longer you take it, the worse the dependence and withdrawal", but in the same breath, "a fast taper will result in withdrawal symptoms and possible protracted withdrawal that lasts many months or years".

So, i feel a bit "stuck".  I am uncertain of how to taper from this dose, if I should rapid taper, or slow taper.  I also am not sure if the few symptoms I am feeling are anxiety driven fears about withdrawals, or if they are actually withdrawals, or even a side effect of introducing the Remeron.

Also, for reference, I am completely deaf in my left ear, and I have neural hearing loss in my right ear, with tinnitus.  The tinnitus has been present for me for 30+ years, but manageable until all of this has happened.  Today is better than yesterday, and tomorrow could be better or worse, there is no real ryhme or reason to it, but it is a primary driver for my anxiety.  You see, if I lose hearing in my right ear, I have nothing because I don't have my other ear to compensate.  I wear a hearing aid system that helps alot, but when the tinnitus is really high, it does not help as much.

That said, my symptoms consist of some dizzyness, tinnitus, and overall groggy and spaced out feeling.  Anxiety is controlled, but present.

So in my post I am looking for several answers or perhaps some reassurances:

1. Am I truly experiencing withdrawal, or is it more anxiety driven?

2. Will a fast taper doom me to PAWS? Or will a longer taper actually cause more problems? (is it necessary to slow taper given the low dose and short time taking the medication?)

3. Are my symptoms more likely to be from side effect of new medication? Or is it withdrawal? And will withdrawal get worse if I cut and discontinue?

4. Have I already tapered too fast by re-instating at half of my original dose?

5. And this one is a big one - how many of you have taken this medication for a similar length of time as I have and have successfully come off of the medication without serious or long term effects?

Thanks for reading! I know it's alot to read, I just want folks to have the whole picture so that I can receive as much accurate advice as possible!

* additional info:

I am functional. I don't feel great, but I don't feel terrible either.  It's very mild in comparison to how I felt a week ago.

The Remeron is actually helping me quite a bit, I sleep very well with this med. Not sleeping is a HUGE anxiety driver for me, so it is a welcomed benefit for me.  They also prescribed this to me because over the last year, I have lost close to 50 lbs.  I am underweight, hanging in there at just about 100 lbs.  (I am petite, but I haven't been 100 lbs since I was 15 years old or so, lol).

One thing I am learning throughout this process is how important self-care is.  I was not eating regularly, I was not sleeping regularly, I was not exercising. I was also not setting boundaries, and a lot of other life stressors have over taken my emotional well-being.  Lots of history there, but the short version of it is that I was raised in a violent home, and suffered several abusive marriages throughout my adult life.  Childhood was very traumatic, having been born with cognitive difficulties that were present at birth, my deafness being only one of them.  Last year, my younger son fell into a drug addiction that nearly killed him.  That was a very tough year. He is recovering, but still struggling with nicotine, THC, and alcohol use.  I recently had to establish some boundaries with him, and that was extremely hard for me.  It has reached the point now, where i have had to make the decision to ask him and his GF to move out as he is working 2nd shift, and he has a large dog living here that is not fixed or trained and he has taken over my whole household.  That is a step in the right direction for me, because without having my own space and home, I am not able to take care of myself the way I need to.  But, it was hard for me to do, because in my history, laying boundaries usually meant either physical or emotional pain, rejection, or dismissal of my feelings and turmoil from arguing, etc.

That all said, the tinnitus increases as my stress level increases.  That has been the case for as long as I have had this. The calmer I feel, the better the tinnitus is.  However, yes, it is still more present now than it was before I started taking the benzos.  The one symptom that did seem to be resolving was the tinnitus after I discontinued the benzos, and it seemed to increase upon re-instatement and introduction of the Remeron.

So, I need to ask, what is a "symptom based taper?" How do I know when to cut? I don't want to be on this medication, and my initial impulse is to rapid taper and get on with my life, but I do not want to cause myself harm or set myself back, either.    I can control the anxiety with breathing, meditation, and yoga. These have worked for me so far, along with a few other tricks I learned while I was on the unit (The DARE method is one of them, I encourage anyone to learn about this, whether suffering from benzo w/d or just with anxiety in general, I wish I had known of this many years ago!)  The only symptom I can't "control" and need to sort of just deal with is the dizziness and the waxing/waning tinnitus, as I am sleeping, eating, and managing anxiety well.  If the physical symptoms of a little grogginess and dizziness all that I have to endure, i am OK with that. Coming off of an SSRI was similar, and I survived that just fine.  So, I guess my question now is, how do I know when it is safe for me to step down and make another cut?

Hi River923

I am sorry you're finding yourself in this predicament. I am a longterm user of Clonazepam, so not really the person you'd like to hear from, however I also have read a gazillion threads on the taper boards trying to figure out my own taper, so I do feel I can offer you an opinion (and you are free to do with it however you please  ).

When we talk about a symptoms based taper we encourage people not to get stuck to a "plan". Lots of people come here because their doctors or psych's or they themselves have a plan to be off in x amount of time regardless of their symptoms. This type of approach often leads to disabling symptoms and can render people non-functional. In a symptoms based approach we advocate for keeping a taper journal where you keep track of your symptoms on a daily basis and adjust your taper rate (%) accordingly to allow you the best possible taper while remaining functional. By functional we mean, being able to do the daily tasks required of you - it doesn't necessarily mean feeling well or being symptom free. So if you keep a journal and you start noticing the severity of your symptoms are increasing, you will either hold or decrease the percentage of your taper (or both).

Your situation is complicated because of your fairly short term use. Some people on short term use can do rapid tapers, other struggle. There's no way we can determine how your body will respond to larger cuts than the recommended 5-10% reductions (and even these ones we cannot vouch for). If you do not want to experience a setback or take a risk of extreme withdrawal, I would say a rapid taper is probably not a good idea. The reason being, if you can't tolerate it, you will experience extreme withdrawal symptoms. When I had a rapid taper I experienced the sweating, nausea, diarrhea and severe stomach upset you were talking about (plus a lot of other symptoms as well).

So when to make another cut? Since it's only been a week (I assume as I don't know what Sunday and Tuesday you're referring to), after your whole ordeal I think you should hold your dose for another week or so and just give your body some time to settle down.

Then when you want to get into tapering it generally it takes around 2-3 weeks for a cut to "work out". I personally don't make any cuts shorter than 14 days but also check my symptoms. With Clonazepam most people will feel the cut between day 3-5 and symptoms will settle around day 10. So I check my symptoms to make sure around day 10 I start feeling better and I continue to feel better until day 14. Then I'll cut again on day 15 (or that will be day 1 of the new cycle).

I hope some of this helps you in your decision. It also helped me to do a lot of reading on these boards and not just take one or two people's opinions, but educate myself as much as I could. 

Thank you!

Yes, you’re correct, it’s been a week. Today is day 9 and yesterday & today I have felt really well. (Not quite 100%, but close)

The first effects I had been feeling was after CT cessation, along with having no sleep for several days and not eating.  I think I’m handling the taper pretty well. 

If going along this line of thinking, I could theoretically cut again this week, stay on that dose for 10-14 days, feel a little yucky for a week,  and discontinue the med.  Feel crappy one more week-ish after that,  & hopefully be free

Is that generally how it’s supposed to work?

Well if you want to rapid taper then you can go from 0.25 to 0.125 and then stop. It will be a 50% reduction initially and if you can't handle it you'll probably have acute symptoms and then have to go back up and hopefully stabilize. If you want a gentle taper approach you can start with a 10% reduction. It's up to you what you want to attempt.

Usually when tapering it's not just about getting off the drugs, there's a recovery period afterwards. Symptoms don't just disappear when you stop taking benzo's. Most of us take a couple of months afterwards to recover as well. There's no way to tell how long recovery will take unfortunately.

You might want to read this thread, it's for members with short-term use http://www.benzobuddies.org/forum/index.php?topic=130001.0