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Are You Glad or Sorry You Updosed or Held?


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Hi,

 

As a "newb" to getting off diazepam, I've asked questions re: updosing and holding, and received different opinions. I wonder if we can get a number of people's actual experiences with respect to this, which may help guide others.

 

Ashton doesn't agree with updosing, and seems kind of equivival about holding. She also says there are no hard and fast rules.

 

The following paragraph is from:

 

http://www.benzo.org.uk/ashsupp11.htm

 

“A dilemma faced by some people in the process of benzodiazepine withdrawal, or after withdrawal, is what to do if they have intolerable symptoms which do not lessen after many weeks. If they are still taking benzodiazepines, should they increase the dose? If they have already withdrawn, should they reinstate benzodiazepines and start the withdrawal process again? This is a difficult situation which, like all benzodiazepine problems, depends to some degree on the circumstances and the individual, and there are no hard and fast rules.

 

Reinstatement after withdrawal? Many benzodiazepine users who find themselves in this position have withdrawn too quickly; some have undergone 'cold turkey'. They think that if they go back on benzodiazepines and start over again on a slower schedule they will be more successful. Unfortunately, things are not so simple. For reasons that are not clear, (but perhaps because the original experience of withdrawal has already sensitised the nervous system and heightened the level of anxiety) the original benzodiazepine dose often does not work the second time round. Some may find that only a higher dose partially alleviates their symptoms, and then they still have to go through a long withdrawal process again, which again may not be symptom-free.

 

Updosing during withdrawal? Some people hit a "sticky patch" during the course of benzodiazepine withdrawal. In many cases, staying on the same dose for a longer period (not more than a few weeks) before resuming the withdrawal schedule allows them to overcome this obstacle. However, increasing the dose until a longed-for plateau of 'stability' arrives is not a good strategy. The truth is that one never 'stabilises' on a given dose of benzodiazepine. The dose may be stable but withdrawal symptoms are not. It is better to grit one's teeth and continue the withdrawal. True recovery cannot really start until the drug is out of the system.

 

Pharmacologically, neither reinstating nor updosing is really rational. If withdrawal symptoms are still present, it means that the GABA/benzodiazepine receptors have not fully recovered (see above). Further benzodiazepines cause further down-regulation, strengthen the dependence, prolong withdrawal, delay recovery and may lead to protracted symptoms. In general, the longer the person remains on benzodiazepines the more difficult it is to withdraw. On the whole, anyone who remained benzodiazepine-free, or has remained on the same dose, for a number of weeks or months would be ill-advised to start again or to increase dosage. It would be better to devote the brain to solving individual symptoms and to finding sources of advice and support. Advice about how to deal with individual symptoms is given in the Manual (Chapter 3).”

 

 

 

 

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Ashton is crazy.

 

Grit one's teeth and push on is NOT a good idea unless one is clearly in a bad way in any case.

 

Small dose corrections have always helped me in the past, holds alone, hmm, sometimes, not always, sometimes a small updose or dose correction has been absolutely necessary for me... otherwise I would not be at the dose I am at now.

 

There was a post on here by someone who saw an Australian neurologist who said that some can taper benzo's in 1-1.5 years whereas others, sadly, needed as long as 6 years. It was his opinion that we do NOT need to suffer as much as we do and his advice was to make a cut and if one does NOT get stable after 2-3 weeks, to go BACK and hold and try again, he said that sometimes the brain is "just not ready" He also said that, in his opinion, 4 week holds were often necessary and that he did not agree that 1-2 week holds were anywhere near long enough between cuts.

 

This has probably been the ONE thing I have read on these boards that seemed to me to make sense.

 

I mean, let's face it, most of us are in a pickle one way or another aren't we?

 

I suppose none of us want to accept that this can take time... although all the evidence points towards increasing post taper recovery time if we do hurry but that rarely seems to deter some people...

 

As Tickety Boo said once: Quicker = sicker.

 

What the neurologist said seemed to me to be pretty bang on as the brain can take time to adapt and we can go slapping time frames on getting stable in between cuts but if we push ahead when the brain is not ready, it WILL complain.

 

I suppose it is pretty hard to say to anyone that this can take years, OK, many can taper far sooner and be healing well a couple of months off but this is rarely the case for the longer term users...

 

 

 

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Hey Oscar,

 

So glad you replied. I'm hoping this thread receives many, which could then help others. I have seen others make "dose corrections," i.e. very small updoses, and do well. I do wonder about that, that, though, and particularly reinstatment and larger "updosing."

 

Take care, and best to you and all of us...

 

Steve

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For me, holding can help, this is a time thing, everyone is different so having a hold of 1-2 weeks, to my mind, is a little too simplistic.

 

Some heal faster than others, some organizations advise on 3 week holds, Ashton says 1-2 weeks, I say listen to your body and if a cut does not stabilize then hold longer and if still not, go back and do it again or just hold longer as long as symptoms are not worsening.

 

The golden rule is simply to never cut if highly symptomatic... it's just like pouring gasoline onto an already fierce fire.

 

Wait it out always... symptoms usually will start to calm down unless one is so ahead of one's own healing in which case it is a bit hard to say what to do really.

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The updose finally, after weeks, helped with many of the physical sx's but she now has a new sx, depression.

The updose definately, created a bunch of new and old sx's initially, but gave some relief from the acute sx's.

The depression makes her breathing panics worse.

I still don't know if this is going to go away because it has been coming daily for the past 9 days.

I am holding for a month to see if things get better.

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Tapering for 16 months off klonopin and halcion following horrendous undiagnosed tolerance and spontaneous withdrawals in October 2012.

 

Still tapering in pain.

 

Never up dosed once.

 

Holding provides only relief but its a roller coaster.

 

This is not fun or easy to me...it has been, so far, the ordeal of my life.

 

Sorry I can't be brighter.

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Great thread....very interested to hear everyone's thoughts and advice. I am at a crossroads right now.

 

Felt good at 1.15mg held for 12 days, dropped to 1.10mg. Been holding for 18 days and 17 of them have been tough. Did a one time dose correction of 20%, didn't help.

 

Do I keep holding or go back to 1.15mg, hold, then try again?

 

One of my concerns, like Mr. mentioned, is up dosing and getting an influx of new sx, and still not really solving my problem. I'll admit, I'm nervous to updose, it's not so much about being stubborn.

 

I'm hoping this thread takes hold and lots of feedback comes pouring in.

 

Stevensy and Mr - good to see you guys here

 

Oscar - we meet again

 

 

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Caught between a rock and a hard place.    Pretty sure valium is reacting really badly in my system.  Seeing a neurologist for terrible, severe nerve pain in buttock/trunk.  Cannot sit or lay on my butt and it's spreading - i am deteriorating daily.  Realise I will be ill all the way off - and ill after I'm off.  But if paradoxical to valium what can I do?  Not sure any other benzo would be any safer for me - am extremely senstive to many meds.    All I can think to do is to get off fast as is safe to do so.  Ashton taper rates were determined to be the safest against seizure and in the belief that the healing needed to start once off teh drugs.    If taking valium is a breeze then going slow is easy.  One Aussie BB is taking 6 months off taper to go on extended family holiday.    I am way too sick to go on a holiday.  Sitting in the car for doctors appointment is very painful.    I am even thinking C/t might be my only chance.      How shocking that doctors did this to us.
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I have put in a few very small up doses and several holds all during my taper and have not regretted any of them.  In every case it is just what was needed in my case and in my opinion to keep misery at bay while my brain's healing rate caught up to my cut rate.

 

I personally think each should do whatever they believe will help when things are rough.  I do not believe in cutting through the pain.

 

My opinion of course  :smitten:

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Hi kiddo,

I had updosed my mom 2 times.

The first time was from .68mg v (held for a month) to .86mg v (held for 15 days) to 1.2mg v (holding for a month) in order to get her sx's under control.

Most of the sx's are far better than what they were at .68mg, but she still is a ways from stable where we can go anywhere.

Technically, had she been cutting at 5% every 14 days, she would have been at 1.67mg v today.

This could be why she is not stable enuf yet but I only have enuf to go up to 1.4mg v if I have to.

Also, I dose her 3 times per day now to help with interdose wd's.

I am just gonna hold and hold until things get good enuf to cut.

 

 

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I'm sorry I up-dosed/held, which is why I tried both only once.

 

I up-dosed (by 5mg of Valium, per my psychiatrist's advice) during my crossover. It helped for a few days, when I was in the extreme throes of a 50% cut from Klonopin, but then it didn't help at all, and I was stuck with months more tapering. It sucked. I regret it.

 

Holding didn't help, either. 

 

I'm now 3+ months out and really, really glad I didn't drag out my taper any longer than it was already. There were many times I doubted "gritting my teeth," but it was absolutely the right decision for me.

 

I really think that--no matter how adamant someone is that they've found THE answer--there isn't one way to do this. We have to trust ourselves more than we trust anyone else.

 

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Check out my thread. Updosing, if done for the right reasons, can sometimes be absolutely needed. I hit problems as I tapered 1mg at a time from 7mg to 1mg...1 week at each dose. by 1mg..I was destroyed! I looked at my documentation of symptoms and doses, did the math on where I probably started going bad and tried to part the symptoms...I went to 1.5 for a couple weeks and came slightly out of it and then back in it. I knew mathematically where I needed to be, but tried coming up a little. I went up to 3mg straight away and held 3 weeks at each dose. At 2mg I tried to go 1.5 and got hammered so I went to 1.75...bueno. I then went to 1.6 where I got hammered again and held. I got past it and began daily micro-tapering. I've been amazing since and am at .16mg today.

 

My technique is all about adjustments as long as they are done smartly and for a reason. arbitrarily adding and decreasing is silly. you need to have a valid logic behind it.

 

Aside from myself, I've seen it work a number of times in other people now who have taken to the C/MST taper techniques.

 

Wellness holds seems to be a key.

 

Some people cross over/updose/etc and have a harder time finding stability. Once you have found that place (it is possible for most) then you really need to incorporate deliberate holds and adjust as needed. If you are cutting and holding and you get the hammer....go up and try a different route. Now, for some peole they never need to do it because their brains adapt faster...for the rest of us, this seems to work well overall. I'm so glad I didn't grit my teeth and white knuckle it like I did at the start. Sometimes I got through it and others I did not. I can tell you this....by adapting I hve been mostly money since getting hammered from a cut and hold from 1.75 to 1.6..... 1.6 now down to .16 in even faster time than I would have on my original cut and hold schedule. it's bueno.

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I haven't updosed but held for longer than anticipated. For instance I held for 5 weeks once I got to 1mg, I needed a break and it worked helping me to stabilise. I've never been sx free however, I haven't been able to achieve that. I've tried different timings for my cut, slowed down considerably in my taper and I cut by slower amounts. The best I got has been to make sxs manageable but not make them go away altogether. I sort of know that I will have some remaining sxs until the very end of my taper and hoping they will improve after in a more speedy way.

I wish I'd known all I know now in the beginning of my taper but there's not going to be a next time. I'll never taper from benzos again, this i know!

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13/14 May-27 June between the two. Ativan gave me bad DR/DR (never figured out what the hell is was until months later when I came here) I just kept wondering when I would get my personality back. I enjoyed nothing. It was all dull,etc,etc. K sedated the shit out of me and simultaneously made me feel the need to walk and walk and walk with high BP and higher pulse. There's nothing worse than you can almost not open your eyes because of the sedation but your heart is going to fast you can't rest or even sit nor concentrate to even watch TV. Then I got approved to start the Ashton taper and switched to Valium. Life was right-way good after the changeover to start.
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After my initial too fast taper on temzepam I updosed to get out of severe acute benzo w/d. I don't regret it for an instance. I've updosed twice since then too. Although the added times have been annoying there were specific circumstances that I'm not likely to come across again that required that particular action. If I think I need to updose again, in order to (a) function (b) continue my taper © not do excessive damage to my brain (d) have my daughter have a mother, I will.

 

I don't believe glutamate exicitoxicity is good for you or your brain.

I therefore don't believe in staying in excessive glutamate excitocity ie. acute benzo w/d

 

Tapers will go too far without you knowing it, other things will happen like concussion. These things will happen in a taper. Why not correct for them?

 

There seems to be a suggestion that if you correct for them then somehow you are increasing a psychological dependence. I don't think you can infer from other addictive behaviors to the case of benzodiazepine dependence. Partly because, I don't believe the majority of benzodiazepinie are psychologically addicted in most senses of the word. Anyone going through the hell of getting off benzos is extremely motivated and if anything want off sooner rather than later. So why act as though an updose, hold, or reinstatement is psychologically addictive-behaviour?  What it is, in my view, is making sure your brain is functioning at its current settings so you can continue to taper and function. And this brings be to the second main reason why you can't infer addictive behaviours to this instance: the crippling, damaging, protracted nature of the w/d.

 

Glutamate excitoxicity in benzodiazpeine withdrawal is so extreme, and the damage so significant, that w/d symptoms can continue for many years. This is a very particular instance of dependence. One that has 'the longest withdrawal period of any drug of dependence' (to quote Ashton). Glutamate exictoxicity is then, in my view, what needs to be avoided. This is in contrast to what Ashton claims should be avoided: the remote possibility of furthering damage to GABA receptors if you stay on benzodiazepines any longer than remotely necessary via updose, holding, or reinstatement. GABA receptors do, in my opinion, up-regulate as long as your overall trajectory is down. People do heal as they taper. One thing that is more likely to cause damage to your brain, GABA receptors and all, is the kind of glutamate excitoxicty that acute benzodiazepine w/d unleashes.

 

I'd have more to say except it is night here and I'm getting tired...

 

In general however one should do whatever works for you.

 

The goal is the same: get off benzos.

 

How you do that successfully is up to you.

 

And there is no real evidence, as far as I can telll, that very occassional updosing hinders one from successfully getting off benzodiazepines. There is plenty of lived experience evidence that suggests making your w/d manageable, in whatever way that means for you, will increase your likelihood of a successful taper and complete permanent cessation of benzo use. That is the goal. Do what works for you.

 

(edit: typos)

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After my initial too fast taper on temzepam I updosed to get out of severe acute benzo w/d. I don't regret it for an instance. I've updosed twice since then too. Although the added times have been annoying there were specific circumstances that I'm not likely to come across again that required that particular action. If I think I need to updose again, in order to (a) function (b) continue my taper © not do excessive damage to my brain (d) have my daughter have a mother, I will.

 

I don't believe glutamate exicitoxicity is good for you or your brain.

I therefore don't believe in staying in excessive glutamate excitocity ie. acute benzo w/d

 

Tapers will go too far without you knowing it, other things will happen like concussion. These things will happen in a taper. Why not correct for them?

 

There seems to be a suggestion that if you correct for them then somehow you are increasing a psychological dependence. I don't think you can infer from other addictive behaviors to the case of benzodiazepine dependence. Partly because, I don't believe the majority of benzodiazepinie are psychologically addicted in most senses of the word. Anyone going through the hell of getting off benzos is extremely motivated and if anything want off sooner rather than later. So why act as though an updose, hold, or reinstatement is psychologically addictive-behaviour?  What it is, in my view, is making sure your brain is functioning at its current settings so you can continue to taper and function. And this brings be to the second main reason why you can't infer addictive behaviours to this instance: the crippling, damaging, protracted nature of the w/d.

 

Glutamate excitoxicity in benzodiazpeine withdrawal is so extreme, and the damage so significant, that w/d symptoms can continue for many years. This is a very particular instance of dependence. One that has 'the longest withdrawal period of any drug of dependence' (to quote Ashton). Glutamate exictoxicity is then, in my view, what needs to be avoided. This is in contrast to what Ashton claims should be avoided: the remote possibility of furthering damage to GABA receptors if you stay on benzodiazepines any longer than remotely necessary via updose, holding, or reinstatement. GABA receptors do, in my opinion, up-regulate as long as your overall trajectory is down. People do heal as they taper. One thing that is more likely to cause damage to your brain, GABA receptors and all, is the kind of glutamate excitoxicty that acute benzodiazepine w/d unleashes.

 

I'd have more to say except it is night here and I'm getting tired...

 

In general however one should do whatever works for you.

 

The goal is the same: get off benzos.

 

How you do that successfully is up to you.

 

And there is no real evidence, as far as I can telll, that very occassional updosing hinders one from successfully getting off benzodiazepines. There is plenty of lived experience evidence that suggests making your w/d manageable, in whatever way that means for you, will increase your likelihood of a successful taper and complete permanent cessation of benzo use. That is the goal. Do what works for you.

 

(edit: typos)

 

Very, Very well put, Smiffy!  :thumbsup:

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I believe we each make decisions related to up dosing and do what is best for our particular situation and tolerance for symptoms.  For me personally, up dosing was not an option I chose to employ.  My focus was on a downward trend rather than retracing a dose I had reduced. 

 

Did I white knuckle it at times during my taper, yes I did.  When those instances occurred, I chose to hold and eventually stabilized and then proceeded downward. 

 

I believe the fact that I was able to tolerate tapering a short acting benzo was a huge advantage for me personally during my taper and recovery.  I did not have to deal with the accumulation factor involved with the longer half life benzos, like Valium, Librium or Klonopin.  Thus, I was able to very quickly determine where I was with each cut and did not need to employ up doses / dose corrections.  My cut and hold style of tapering also helped me a great deal with knowing exactly where I was with each cut because my lag time was very predictable.  I like things to occur in a predictable fashion.

 

I believe the accumulation factor might play a role as to why I see so many low dose folks struggle in stopping the last bits of Valium and also why Valium tapers generally seem to take so much longer than short half life benzo tapers.  I've only seen 1 Xanax user the entire time I've been on BenzoBuddies, who had to taper the last bits of Xanax in a really stretched-out amount of time.  So for folks who can manageably tolerate tapering a short half life benzo, (only IF you are tapering your original benzo), this might work out to be an advantage for you too, like it did for me. 

 

We each choose our path to freeing ourselves from these meds and there is no one single path that fits us all.  Good luck everyone.

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First of all, I do not believe Dr. Ashton is crazy and saying that is inappropriate.

 

I did a rapid taper and am very glad I sucked it up and pushed on.  I was in wicked tolerance to begin with and I only really started to heal after I got the poison out of my system. 

 

When I first started reading this forum 1 1/2 years ago I almost believed I was in for years of drawn out w/d hell due to my rapid taper.  Turns out it was a big fat lie.

 

And after reading this forum all these months I am of the opinion that those who choose to draw this out for years are often as addicted to their tapers as they are the benzos.  And as for scaring people with the "protracted withdrawal" bogie man, well, that is a benzo myth I have personally busted.

 

Be Well

China

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During my taper I made a horrible mistake going from 15mg to 12.5 mg in one jump. The result was unendurable. I up dosed that one time to where I made the wrong turn, 15mg, and then held for about three weeks until I stabilized, then made more careful reductions and longer holds. No, I don't regret it, it was the right thing to do at the time and brought instant relief.
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First of all, I do not believe Dr. Ashton is crazy and saying that is inappropriate.

 

I did a rapid taper and am very glad I sucked it up and pushed on.  I was in wicked tolerance to begin with and I only really started to heal after I got the poison out of my system. 

 

When I first started reading this forum 1 1/2 years ago I almost believed I was in for years of drawn out w/d hell due to my rapid taper.  Turns out it was a big fat lie.

 

And after reading this forum all these months I am of the opinion that those who choose to draw this out for years are often as addicted to their tapers as they are the benzos.  And as for scaring people with the "protracted withdrawal" bogie man, well, that is a benzo myth I have personally busted.

 

Be Well

China

China,

Most people do not want have to go to the ER and be bed ridden the first few months off of a rapid taper.

My mom did a rapid taper off lorazepam the first time and was doing very well 5 months off, but she was down to 89 lbs, low albumen due to malnutrition and she was bed ridden the first 3 months.

Unfortunately, she reinstated prn thinking it would be okay after 6 months off and it did damage to her respiratory center in the brain.

Her only choice was to micro taper off.

Some people going thru this have to work and a slow micro taper is one way that has proven to work.

Some people have been on them many years and others may have kindling going on or multiple drugs to taper off.

 

For those who can white knuckle thru it and can afford to be bedridden, hey go for the ashton taper.

However, looking at Dr Ashton's outcomes of 50 patients, only 2 were recovered to excellent <12 months off.

 

These are all just choices for people and not one protocol for everything, so it is not appropriate to knock other methods because they all have a purpose.

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During my taper I made a horrible mistake going from 15mg to 12.5 mg in one jump. The result was unendurable. I up dosed that one time to where I made the wrong turn, 15mg, and then held for about three weeks until I stabilized, then made more careful reductions and longer holds. No, I don't regret it, it was the right thing to do at the time and brought instant relief.

Hi new moon,

How long was the longest hold that you did?

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[1e...]
hi, im at the beginning of taper, and I find this thread very interesting, informative. Im just now at the time where I need to start deciding how long I will hold and how much I want to cut next time. Doing well so far :-\:)
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mrtmeo,

 

I worked thru my taper and w/d also, and trust me, it was pure hell.  I would do it again tho because 14 months later I am 99 percent healed and if I had let the fear mongers scare me into a long drawn out taper I would still be doing it and probably still sick.  And as you can see from my sig I tapered a lot quicker then even Dr. Ashton recommends.  And I will continue post  my experience because it is an under represented outcome of benzo withdrawal.  And not under represented because it it rare, but because most people who heal quickly, leave quickly.  I have seen it many times in the last 17 months. 

 

If you choose to micro taper that is fine, however, calling Dr. Ashton crazy and assuming that everyone has to microtaper or even should microtaper is what is crazy and totally inappropriate.  You are the one saying that to follow Ashton protocols would automatically mean you are going to wind up in the ER, be bedridden, and suffer terrible for months and years on end.  I am here to STATE that is NOT true.  So who's knocking who here? 

 

And BTW.. I had two previous rapid benzo withdrawals before I even knew what benzo withdrawal was. 

 

Again, I will state to the OP's question.  No I didn't and I am glad I didn't hold or up dose. 

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First of all, I do not believe Dr. Ashton is crazy and saying that is inappropriate.

 

I did a rapid taper and am very glad I sucked it up and pushed on.  I was in wicked tolerance to begin with and I only really started to heal after I got the poison out of my system. 

 

When I first started reading this forum 1 1/2 years ago I almost believed I was in for years of drawn out w/d hell due to my rapid taper.  Turns out it was a big fat lie.

 

And after reading this forum all these months I am of the opinion that those who choose to draw this out for years are often as addicted to their tapers as they are the benzos.  And as for scaring people with the "protracted withdrawal" bogie man, well, that is a benzo myth I have personally busted.

 

Be Well

China

China,

Most people do not want have to go to the ER and be bed ridden the first few months off of a rapid taper.

My mom did a rapid taper off lorazepam the first time and was doing very well 5 months off, but she was down to 89 lbs, low albumen due to malnutrition and she was bed ridden the first 3 months.

Unfortunately, she reinstated prn thinking it would be okay after 6 months off and it did damage to her respiratory center in the brain.

Her only choice was to micro taper off.

Some people going thru this have to work and a slow micro taper is one way that has proven to work.

Some people have been on them many years and others may have kindling going on or multiple drugs to taper off.

 

For those who can white knuckle thru it and can afford to be bedridden, hey go for the ashton taper.

However, looking at Dr Ashton's outcomes of 50 patients, only 2 were recovered to excellent <12 months off.

 

These are all just choices for people and not one protocol for everything, so it is not appropriate to knock other methods because they all have a purpose.

 

Where did you get 2 out of 50?  ???

 

Maybe I'm missing something, but the following cites an "excellent" outcome with the Ashton protocol in 24 of 50, with a "good" outcome for a further 22% (11):

 

"The outcome was graded as excellent in 24 patients (48%), good in 11 (22%), moderate in 8 (16%), poor in 3 (6%) and failed in 4 (8%). Thus, 70% of this group did excellently or well after withdrawal and a further 16% were moderately improved. All these patients claimed to feel better after withdrawal than when they were taking benzodiazepines and were glad they had withdrawn."

 

http://www.benzo.org.uk/ashbzoc.htm

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