Help: Should I taper? If so, how?

Hello all.

 

I'm going through a really rough time, and I need your help and suggestions.

 

I have been on benzodiazepines on and off for the past five to six years. I've taken Xanax (alprazolam) 0.25 and 0.5 mg, Valium (diazepam), 2 - 10 mg, and Klonopin (clonazepam), 0.25 and 0.5 mg, once or twice. I've never gone above these doses, and for Valium, I mostly stay between 2 and 5 mg, only going above them during emergencies.

 

I was also briefly on zopiclone for insomnia, which was hell on earth, but quit it for good after a couple of months of intermittent use. I'll never go back on it ever again.

 

My use has been very irregular and erratic. I have always taken it on an on and off basis, and never more than few days in a row. The one exception is when I had a very severe crisis last year, when I was coming off zopiclone, and I had to start with 10 mg of diazepam in December 2016, and slowly taper it down, over two months, to nothing. The last pill I took was in Feb. 2017. However, I have of late been using diazepam again, 2 mg mostly, sometimes 4 mg, to help with transient insomnia, roughly once or twice a week. And last week, as I moved back to England, the jet lag triggered a massive state of panic attacks and anxiety, and on Monday, I took 8 mg of diazepam to cope (lower doses did not work), and yesterday, I took 7 mg, as I didn't sleep a wink the day before.

 

I have in the past been able to go off benzos for few months, sometimes several months. However, I somehow always end up going back on it, due to debilitating anxiety, insomnia, or panic attacks. They are the only drugs that can save me in these very, very rough patches. Jet lag is a big trigger, but sometimes a night or two of sleeplessness will be enough to set off a crisis.

 

I do think I'm psychologically dependent, as I'm afraid to travel without diazepam, and every time I have anxiety or insomnia, my first thought is whether or not to take a pill. This is also because all my other attempts to cope with my anxiety and insomnia using CBT, psychotherapy, antidepressants, mood stablisers etc. have failed. (My psychiatric and pharmacological history is a long and complex one.)

 

And I do think I need to quit them for good, as it has exacted a very heavy toll on all aspects of my life.

 

My question is: should I taper? or given my history, can I afford to quit cold turkey? My husband worries about tapering, because he thinks that I've taken it so irregularly, or rather, so intermittently, that there is no chemical dependence, just psychological one. And by tapering over several weeks, he worries I'll add physical dependence as well.

 

What do you guys think? And if I should taper, do you think I could afford to start at 5 mg, and reduce by 1 mg a week, to quit over four or five weeks, thereby minimising the chances of further dependence?

 

Any and all advice is welcome, as are further questions. But please use your discretion -- as I'm very, very vulnerable, and need all the kindness and support I can get. And I need to believe that I can both come off this drug, and that it is the right thing. There is much scare-mongering out there. And I'm scared enough as it is. I hope you understand.

I have always taken it on an on and off basis, and never more than few days in a row.

 

Assuming this is still true, it remains that way, and you aren't having to increase your dose to get relief I wouldn't taper. Taper requires taking it every day and you would likely end up physically dependent.

 

In my humble opinion the only valid use for benzo is short term for debilitating anxiety. If I was able to take them only as needed without becoming dependent I honestly wouldn't even quit, but I have an addictive personality and got myself hooked.

I have always taken it on an on and off basis, and never more than few days in a row.

 

Assuming this is still true, it remains that way, and you aren't having to increase your dose to get relief I wouldn't taper. Taper requires taking it every day and you would likely end up physically dependent.

 

In my humble opinion the only valid use for benzo is short term for debilitating anxiety. If I was able to take them only as needed without becoming dependent I honestly wouldn't even quit, but I have an addictive personality and got myself hooked.

 

Thank you, smiley76, for your comment. It was very helpful. My husband feels the same way. I do have debilitating anxiety and insomnia -- to the extent that it required hospitalisation last year. That was the only time I went on benzos for two months in a row. I quickly tapered off, and did not take it for a few months.

 

But this week has been very rough, jet lag is a massive trigger, and it has given me flashbacks of the past few attacks. And I feel unduly guilty everytime I do take a diazepam or two, you see. And because I took a higher dose than normal this week -- but each three days apart -- I got frightened.

 

Would you still say I shouldn't taper?

Taper is for people who are taking the medication every day, are physically and mentally dependent and need to gradually reduce their daily dose to avoid symptoms.

 

It's up to you ultimately to decide if that is appropriate in your case but I'm not seeing it based on what you are describing. Increasing your dose is a bad sign but if you are able to take the medication three days apart without going into withdrawal taper doesn't make any sense to me.

 

Whether or not you should keep taking the drug to avoid eventually become dependent is debatable, it sounds like the real question you need to figure out is if you want to quit. And if you are able to stop without withdrawals i would not start dosing daily. That's just me and I only share what I would do in that position, I'm not really comfortable giving direct advise.

Taper is for people who are taking the medication every day, are physically and mentally dependent and need to gradually reduce their daily dose to avoid symptoms.

 

It's up to you ultimately to decide if that is appropriate in your case but I'm not seeing it based on what you are describing. Increasing your dose is a bad sign but if you are able to take the medication three days apart without going into withdrawal taper doesn't make any sense to me.

 

Whether or not you should keep taking the drug to avoid eventually become dependent is debatable, it sounds like the real question you need to figure out is if you want to quit. And if you are able to stop without withdrawals i would not start dosing daily. That's just me and I only share what I would do in that position, I'm not really comfortable giving direct advise.

 

smiley76, I appreciate your reluctance to give direct advice -- but I think you are very wise. However difficult your own journey, for which you have all my sympathies, I think it has made you acutely perceptive.

 

You are right -- the question is whether I want to quit, and quit for good. I do, I really really do -- but I'm terribly, terribly afraid. Afraid of panic attacks, of anxiety, of insomnia, of madness.

 

And I am somewhat psychologically dependent, which is the main problem. So, while I was able to go three days without the pill, I couldn't sleep the first day after the first pill, nor on the third night. (Jet lag would explain the first sleepless night, I'm not sure about the third.) I was extremely afraid that I might not sleep again without the help of a pill, which is the main source of my anxiety, and which, when it becomes intense, can develop into severe panic attacks. Hence the second dose last night. And I interpreted both the sleepless nights as rebound insomnia and anxiety from the intermittent doses of diazepam I had taken this week and last.

 

What I'm not sure of is whether the anxiety and insomnia I've had this week, and at other points over the past few months, counts as "withdrawal symptoms", or if it is independent of benzos, which means I need to look at other means to cope. From what you seem to suggest, it doesn't seem like genuine withdrawal, but rather my inability to cope with the fear of sleep, and the anxiety born of it. Does that make sense? Also, for what it's worth, ever since I quit in Feb 2017, I've taken benzos only intermittently, at most once a week, rarely twice, and at the lowest possible doses.

 

In the light of your post, I'm now wondering whether to quit benzos altogether, and try amitryptyline instead for a short period, as the Ashton manual suggests, to deal with insomnia and anxiety, until such time I gain confidence in my own ability to sleep and cope with anxiety.

 

Any thoughts?

 

I really appreciate your taking the time to reply, by the way.

I agree that a taper likely isn't necessary, and other drugs might help get you through a rough patch with fewer side effects. I wish I had found remeron before klonopin because I wouldn't have needed the Klonopin at all.

I'm even more reluctant to diagnose anyone, especially over the internet, than give advice. That being said I'll give you an opinion

 

It sounds more like anxiety disorder than benzo withdrawal because you are describing the psychological symptoms but not the physical ones (extreme fatigue, irregular digestive track and stomach cramps/pain, sweating, burning sensation, ringing in the ears, seizures, list goes on). Because the psychological symptoms of anxiety disorder and withdrawal are the same it's still hard to say. Short term if you started taking a daily dose I suspect most of your issues would go away, until eventually your body needs it, then eventually it just stops working, then you have to come off and deal with both mental and physical symptoms. That's when you have to slowly taper off.

 

My only suggestion is maybe try support groups for anxiety and possibly drug use if you really want to quit and are having a hard time. There is a sub forum on this site for anxiety if you look on the main page so that's one place to start. AA and NA are support groups to help people stay quit from drugs and alcohol, I couldn't say if thats a good fit for you but they will help pretty much anyone who wants support to stay off drugs.

 

Good luck either way. If I was able to take benzo once or twice a week at low dose and get relief I would be thrilled, but I'm an addict through and through and cant do it. Obviously you are suffering and need to change something, and I wish you luck but if I was you I wouldn't fall into the trap of getting a physical addiction to benzos.

 

 

Well, I took 4 mg of diazepam last night (after 7mg the previous night, and no drug the three nights before), and here I am, at 4 AM in the morning, unable to sleep. Now thinking of adding another 2 mg.

 

No anxiety though.

 

It seems as if I have either become tolerant to the hypnotic effects of diazepam, or that I'm having a paradoxical reaction to the drug, which apparently is possible.

 

And I have a long-haul flight to catch to India.

 

I no longer know what to do. Should I quit benzos altogether, while I'm still slightly ahead, and take amitryptyline or mirtazapine? Or should I taper, given the rapid tolerance -- over three intermittent doses, over two weeks -- I've developed to its hypnotic effect?

 

My doctors want to put me on antipsychotics instead. But that I'm not willing to do. I'm suffering enough as it is. Why add further suffering?