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Pros and cons of Titration versus cut and hold...?


[mo...]

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Hi,

 

After crossing over from Ativan to Valium, things were going pretty well (see signature below) until I cut from 9mg V to 8mg V, so I held for 21 days (instead of just 10-14 days as Ashton suggests) because I started experiencing some difficult sxs, in particular hellacious and tenacious headaches along with elevated heart rate and erratic blood pressure, which, given my already existing heart condition, makes my docs nervous. My medical team (primary care doc, cardiologist, neurologist and psychiatrist) have all gotten on board the Ashton Protocol after I introduced them to it, so that has been great, but now I think the Ashton may be too much too fast for my current situation so I am seriously considering adding a liquid titration (probably with vodka) to my V tablet regimen, but I can find no actual research on the NIH or PubMed about this method — only anecdotal evidence here on BBs, which sounds fine, but I would like to get my docs to work with me and having some hard data on the method would be great.

 

Anyone have any links to research on titration of benzos for taper w/d? I can see the potential advantages of this method, but am wondering about disdvantages? Problems? Stumbling blocks? Success and failure rates for this method as versus cut and hold? Any actual science to back it up?

 

I am currently at 7.5mgs V and when I cut this last time, by only .5mg (HALF of what Ashton suggests for this stage) I still experienced the sxs so I am thinking that if I can add a liquid titration to slowly cut 1mg over a period of time from my dosing every month or so, while using my tablet regimen for the rest of the dose, then maybe my heart, head and BP sxs will ease up? Is 7.5mgs V too high a dose to start using titration? Don't people usually wait until they are down to the 5mgs or 3mgs dose before going to titration? I'm thinking my titration dose might look something like this:

 

starting at 7.5mg V in tablets. Taking 7mg V per day in tablets and titrating down the .5mg in liquid form over a couple of weeks then going to 6mg in tablets and titrating down by 1mg in liquid form over a month or so to get to 5mg, etc. Does this make sense?

 

THANK YOU for any and all info, shared experiences and advice. I really appreciate it!

 

Mo

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[7c...]

I don't recall seeing a published article on micro-tapering, but the logic for doing a daily cut versus bi-weekly cuts is simply an extension of the logic for doing cuts instead of doing a c/t.  Smaller cuts are easier on your body, and daily cuts are smaller than bi-weekly cuts (which are smaller than a c/t jump).

 

The only 'con' that I can think of is that some people struggle with the calculations for doing daily cuts.  If you can do 6th grade math, it shouldn't be a problem for you.

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Yeah, I don't think you are going to find a shred of research on tapering other than what is on forums.  We are on our own in that regard.

 

7.5mg is fine.  I don't know why people wait.  If I were starting a new taper (God forbid) I'd do a daily taper from day one.  I think a daily cut of .03mg would be about right for you to begin and see how it goes.  You could then move up from there.  .03mg is a little less than 1mg a month.

 

Yes, your example makes sense.  Most people do minimize the liquid, although you can also liquify the whole dose if you want.  Both work.  It is preference.

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There are 2 parameters to a cut-and-hold taper:

 

1) The cut is the amount that you reduce your dosage...its the amount of med your system must adapt to doing without.

 

2) The hold is the amount of time you allocate to allow your system to adapt to that reduction.

 

It is the CUT that disrupts your system.  It is the CUT that causes the onset of symptoms.  The impact and discomfort of a given CUT is going to be the same, no matter how long you hold. Holding longer  will NOT reduce the severity of the initial sxs, it will only (hopefully) offer time to recover from the initial shock.  Smaller cuts will reduce the severity of sxs, but longer holds will not.

 

A daily taper is really just C&H taper with really  tiny cuts, and really short (24 hr) holds.  Since "...smaller  cuts will reduce the severity of the sxs", it should be pretty obvious why a daily taper is the most gentle way of dealing with a dependency on benzos.

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Thank you badsocref, SG57 and builder!

 

This is exactly what I need to hear right now and I'm going to try the liquid micro-tapering with vodka — I've been reading a couple of threads and links on how to do this. It is really helpful to have you suggest a dose SG57 since that was one of my concerns...where to start? .03mg (which I believe is 3mls if I do 1mg V to 100mls liquid) is the number I will use to start, even though it seems like such a small amount! But, if I understand the micro-tapering method, I am cutting by 3mls every day so on day one I will take 97mls of the solution and then on day two I will cut by 6mls and take 94mls of the solution, etc...and take the rest of my doses in dry tablet form.

 

Any evidence that titrating with vodka causes any issues with GABA receptors? I am assuming that the ethanol dose is so small in relation to the total solution of vodka mixed with water and diazepam that it's negligible? It is also my understanding that not only does V actually go into solution (rather than suspension) when using vodka, but that the vodka preserves the solution for awhile and does not spoil as readily as milk? Or does the vodka solution loose potency or spoil over time as well? And they said alcohol should never be mixed with benzos... ;)

 

Thanks again. I am actually feeling a renewed since of hope that I will be able to keep cutting by micro-tapering AND still go to work instead of having to hold until spring term is over. I am in such a hurry to be off this stuff that I really have to make myself slow down and this sounds like it might really be workable.

 

Warm regards to all of you!

 

Mo

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There are 2 parameters to a cut-and-hold taper:

 

1) The cut is the amount that you reduce your dosage...its the amount of med your system must adapt to doing without.

 

2) The hold is the amount of time you allocate to allow your system to adapt to that reduction.

 

It is the CUT that disrupts your system.  It is the CUT that causes the onset of symptoms.  The impact and discomfort of a given CUT is going to be the same, no matter how long you hold. Holding longer  will NOT reduce the severity of the initial sxs, it will only (hopefully) offer time to recover from the initial shock.  Smaller cuts will reduce the severity of sxs, but longer holds will not.

 

A daily taper is really just C&H taper with really  tiny cuts, and really short (24 hr) holds.  Since "...smaller  cuts will reduce the severity of the sxs", it should be pretty obvious why a daily taper is the most gentle way of dealing with a dependency on benzos.

 

This was interesting to read and really makes sense. I remember when I first got on BBs and seeing all these tiny little numbers in signatures that I did not want to make my life so complicated just to get off benzos, but now having experienced the difficulty of what I think is kindling (and just being older) and understanding the nature of micro-tapering, it really makes sense to me. Just wondering WHY this has not been studied and is not more widely used in the medical field? The scant studies that do exist certainly seem to suggest that slower, lower cuts may result in faster healing and fewer protracted w/d sxs, so you would think micro-tapering would be the new "hot topic" for benzo w/d studies and treatment, but 40 years after my first C/T w/d I am still running into docs who have never heard of Ashton, let alone micro-tapering and have no idea of the insidious nature of benzos and the difficulties many have with these meds.

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[7c...]

Any evidence that titrating with vodka causes any issues with GABA receptors? I am assuming that the ethanol dose is so small in relation to the total solution of vodka mixed with water and diazepam that it's negligible?

 

Yes - the amount of alcohol is so small as to be of no concern.

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Thanks badsocref! Just learned that it only takes 1ml of alcohol to dissolve 1mg of V, so when added to 99mls of water, you are right that 1ml etoh IS a really low amount!

 

As you all may have figured out by now I just can't stop trying to figure out the hows and the whys so, I am still wondering...

 

With microtapering, is the brain actually healing and repairing itself a little bit at a time with each of the micro taper cuts? I totally get that it would be less stress on the brain and body, but does there have to be a certain amount of "stress" on the GABA system to make it respond by repairing itself? Does it recognize micro tapers and repair itself a little bit at a time OR is there a point at which all the tiny cuts "build up" and the brain goes into w/d sxs and one needs to hold anyway for sxs to subside while the brain/body catch up? Anyone know anything or read anything about this? What little I have found in the data banks is really unclear about it all...

 

Thx!

 

Mo

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Thanks badsocref! Just learned that it only takes 1ml of alcohol to dissolve 1mg of V, so when added to 99mls of water, you are right that 1ml etoh IS a really low amount!

 

As you all may have figured out by now I just can't stop trying to figure out the hows and the whys so, I am still wondering...

 

With microtapering, is the brain actually healing and repairing itself a little bit at a time with each of the micro taper cuts? I totally get that it would be less stress on the brain and body, but does there have to be a certain amount of "stress" on the GABA system to make it respond by repairing itself? Does it recognize micro tapers and repair itself a little bit at a time OR is there a point at which all the tiny cuts "build up" and the brain goes into w/d sxs and one needs to hold anyway for sxs to subside while the brain/body catch up? Anyone know anything or read anything about this? What little I have found in the data banks is really unclear about it all...

 

Thx!

Mo

 

Hi Mosart,

 

My own feeling is that the brain and CNS are built to up-regulate and down-regulate on the fly and that these adjustments are routine daily business and happen 24/7 as needed even in a healthy drug-free state.  All the neurotransmitter/receptor systems are adjustable.

 

When a slight shortage of benzo is created they respond with up-regulation and I don't think it takes much.  So if we can keep the shortage slight we can feel good and taper too.  The shortage is not enough to make us feel bad, but is enough to stimulate up-regulation.  It's like dangling a carrot in front of a horse.  At least this is how I have come to view it.

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Your right around the dose when many have trouble with Ashton. I kept pushing to 5 and the wheels came off. Wish I had moved to daily taper at 8mg - instead started when I was in trouble at 5.

 

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Hi Mark,

 

Looks like you are nearly finished. How are you doing? Have you noticed an uptick in symptoms as you get closer to the end or has it been pretty good? I often wonder if I will feel better or worse bringing it to a close.

 

TH

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This was interesting to read and really makes sense. I remember when I first got on BBs and seeing all these tiny little numbers in signatures that I did not want to make my life so complicated just to get off benzos, but now having experienced the difficulty of what I think is kindling (and just being older) and understanding the nature of micro-tapering, it really makes sense to me. Just wondering WHY this has not been studied and is not more widely used in the medical field? The scant studies that do exist certainly seem to suggest that slower, lower cuts may result in faster healing and fewer protracted w/d sxs, so you would think micro-tapering would be the new "hot topic" for benzo w/d studies and treatment, but 40 years after my first C/T w/d I am still running into docs who have never heard of Ashton, let alone micro-tapering and have no idea of the insidious nature of benzos and the difficulties many have with these meds.

 

Hello Mosart.  I haven't seen any studies which show  "slower, lower cuts may result in faster healing and fewer protracted w/d sxs".

We here in BenzoBuddies tend to hold the view that slower is better and slower gives rise to less PAWS but it is really only a supposition.  It is often more comfortable to taper slowly ... but even that's not true if you're in significant tolerance.

 

 

 

 

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I have been feeling better and better - normal.. actually really great 85-90% of the time. This is a stark contrast to being a total mess at 5mg when I started milk daily cuts. Stabilized - went to daily cuts - and would feel  good much of time and manageable symptoms the rest. Last 6-8 months very good most of time.  No doubt that I have been healing on the way down .. been  trying to keep the cuts at a level that allow it.
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Great...glad to hear it! I have been a little aggressive with climbing the ladder with my daily cut rate,but nothing a day or two hold won't take care of. I'm at a .0037 cut rate now and I'm thinking that's where I might stay.Probably not feeling as good as you,but I have been on it quite a long time, so I'm not expecting miracles. Great to hear that there is healing on the way down.I'm feeling  a bit of that as well. Hoping you have an easy jump.

 

TH

 

 

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Thanks badsocref! Just learned that it only takes 1ml of alcohol to dissolve 1mg of V, so when added to 99mls of water, you are right that 1ml etoh IS a really low amount!

 

As you all may have figured out by now I just can't stop trying to figure out the hows and the whys so, I am still wondering...

 

With microtapering, is the brain actually healing and repairing itself a little bit at a time with each of the micro taper cuts? I totally get that it would be less stress on the brain and body, but does there have to be a certain amount of "stress" on the GABA system to make it respond by repairing itself? Does it recognize micro tapers and repair itself a little bit at a time OR is there a point at which all the tiny cuts "build up" and the brain goes into w/d sxs and one needs to hold anyway for sxs to subside while the brain/body catch up? Anyone know anything or read anything about this? What little I have found in the data banks is really unclear about it all...

 

Thx!

Mo

 

Hi Mosart,

 

My own feeling is that the brain and CNS are built to up-regulate and down-regulate on the fly and that these adjustments are routine daily business and happen 24/7 as needed even in a healthy drug-free state.  All the neurotransmitter/receptor systems are adjustable.

 

When a slight shortage of benzo is created they respond with up-regulation and I don't think it takes much.  So if we can keep the shortage slight we can feel good and taper too.  The shortage is not enough to make us feel bad, but is enough to stimulate up-regulation.  It's like dangling a carrot in front of a horse.  At least this is how I have come to view it.

 

THANKS SG57 — That really does make total sense to me as the body and brain are http://constantly making really minute changes at the cellular and molecular level all the time — so now I'm sort of having one of those "duh" :idiot: moments. I needed a reminder and some reassurance! I think I am just frustrated with the fact that this time around I am having so much trouble with the same Ashton Taper I used so easily and successfully that last time and I need to go ahead and let go of that and try the titration.

 

Regards,

 

Mo

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Your right around the dose when many have trouble with Ashton. I kept pushing to 5 and the wheels came off. Wish I had moved to daily taper at 8mg - instead started when I was in trouble at 5.

 

Hi Mark,

 

Thanks so much for adding your comment — it is very reassuring to me. I got into trouble going from 9mg to 8mg and then even going 8mg to 7.5mg while trying to follow Ashton so knowing that I am not the only one is very helpful since I thought micro tapers had to start at lower doses and I am really struggling right now. I have seen several people here on BBs state they wish they had started the micro tapering sooner in the process so I'm going to go ahead and give it a try!

 

Thanks again,

 

Mo

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Your right around the dose when many have trouble with Ashton. I kept pushing to 5 and the wheels came off. Wish I had moved to daily taper at 8mg - instead started when I was in trouble at 5.

 

Hi Mark,

 

Thanks so much for adding your comment — it is very reassuring to me. I got into trouble going from 9mg to 8mg and then even going 8mg to 7.5mg while trying to follow Ashton so knowing that I am not the only one is very helpful since I thought micro tapers had to start at lower doses and I am really struggling right now. I have seen several people here on BBs state they wish they had started the micro tapering sooner in the process so I'm going to go ahead and give it a try!

 

Thanks again,

 

Mo

 

There is no such thing as "too soon" for a microtaper.  If I had it to over again, I would have started microtapering from the very beginning.

 

I was at max dose of 15mg, and did C&H from 15 down to 9.  I had significant sxs after each .5mg cut, but I always stabilized after a few days.  But when I tried to go from 9 down to 8.5, my sxs were worse, and I never stabilized, so I went back up to 9, and stayed at 9mg for about 2 years.  Then I learned about daily/microtapering, got a scrip from my doc for liquid V, and started my successful, almost symptom free journed off of benzos.

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Your right around the dose when many have trouble with Ashton. I kept pushing to 5 and the wheels came off. Wish I had moved to daily taper at 8mg - instead started when I was in trouble at 5.

 

Hi Mark,

 

Thanks so much for adding your comment — it is very reassuring to me. I got into trouble going from 9mg to 8mg and then even going 8mg to 7.5mg while trying to follow Ashton so knowing that I am not the only one is very helpful since I thought micro tapers had to start at lower doses and I am really struggling right now. I have seen several people here on BBs state they wish they had started the micro tapering sooner in the process so I'm going to go ahead and give it a try!

 

Thanks again,

 

Mo

 

There is no such thing as "too soon" for a microtaper.  If I had it to over again, I would have started microtapering from the very beginning.

 

I was at max dose of 15mg, and did C&H from 15 down to 9.  I had significant sxs after each .5mg cut, but I always stabilized after a few days.  But when I tried to go from 9 down to 8.5, my sxs were worse, and I never stabilized, so I went back up to 9, and stayed at 9mg for about 2 years.  Then I learned about daily/microtapering, got a scrip from my doc for liquid V, and started my successful, almost symptom free journed off of benzos.

 

Hey,

 

Thanks for chiming in! That's exactly what seems to have happened to me...before I went from 9mg V to 8mgs V I had sxs, but could carry on and seemed to stabilize after the doses. However, now I'm cutting less and holding longer and I just spent 3 days in seizure migraine status so something is not working.

 

It's interesting that you found you had to go back up to stabilize...I am really hoping I don't have to do that. I have to go back to the neurologists tomorrow to "discuss my taper" due to the seizures and I will be taking a liquid micro taper plan with me to show them in hopes they will support it.

 

It REALLY helps me to hear you say not only that you wish you had done the micro taper sooner, but that it substantially lessened your sxs. If I can't stop the seizures, then I am looking at having to increase the benzos and stay on them for the rest of my life or take some other nasty anti-seizure medications while trying to get off the benzos and neither option sounds like a good one for me at this point, but at my age having 3 days of seizures is also not good so I'm feeling pretty stuck right now.

 

Hopefully the micro titration will be the answer and I am staying positive about it! Besides, I bought all the stuff to do it... ;)

 

Regards,

 

Mo

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