How Slow is "Slow" When it Comes to Psychiatric Drug Tapering?

Hi!

I stumbled over this article and while reading it, I can see that the author addressed amongst other interesting topics the Fixed Quantity reduction vs the Fixed Percent reduction. This is the very first time I happened to read something so specific to the taper techniques that I hardly believed my eyes!

The explanation provided was clear and the example of Jack & Jill should allow buddies to better understand what I have been trying to deliver in my post for the same topic.

Here is the link for the entire article:

Psychiatric Drug Taper Rates: A Review and Discussion

Here are some extractions:

Hope this time the message can be better perceived thus raising necessary awareness to taperers.

Wish you a smooth journey towards a full recovery.

Jim - thanks much for this article. I don't understand however the last paragraph ...what does it mean? is it better to go with the first approch, 5% of the initial dosage?

Thanks,

Mary

So while Jill’s approach lengthens the amount of time spent tapering, especially during the mid-to-late stages of withdrawing, many experienced laypeople report that this smoother, decelerating pace seems to be a vitally helpful approach for more responsible tapering. This may be in part because it’s common for a taper to become more difficult in its later stages.

Of course, in order to prevent a taper of this kind from continuing indefinitely, at some point in the mid-to-later stages it does become necessary to slightly increase the taper rate again and make some larger dosage ‘drops’ to get fully off a drug, but by that point dosage sizes are becoming so small that even these drops are relatively tiny.

Jim,

Could I ask for you advice? I jumped off May 1st. ( I consumed 30 pills .5 K from 8/17-12/17)

From January to March 2018, consumed 40 pills .5K (cut it to .25 most of the time). I had a panic attack in February, possibly combination of unintended C/T (didn't know about needing to taper) and prescribed zoloft and xanax (which I stopped after a week). Rapid taper per doctor in April from .25 > .125 > .06125 > .03++. So far during wk1 off, sx have been "mild" to mod (akathisia, despair, insomnia, hypnic jerks, confusion, memory lapses). Wk2 (this week, terrible head aches, awful plus all the others from previous week).

My taper was too rapid, perhaps. i wanted off the meds because I was having withdrawal sx already in March. I was miserable. So far, these past 2 weeks, I've been functional but not full-time at work. I wonder if I should reinstate to do liquid titration? I am concerned about the headaches and the memory lapses. But maybe re-instating would not be such a great idea. Anyone?

Hi zack55

I don't understand however the last paragraph ...what does it mean? is it better to go with the first approch, 5% of the initial dosage?

My understanding is that the more you approach the end, the lower will be the daily dose. The lower is the daily dose, the lower will be the reduction which is a percent of the daily dose. It may actually take long time with this method to arrive to the jump dose.

I think this article tries to put forward the low taper speed as the key for a successful taper. From this viewpoint Jill'a approach is best as it will raise less symptoms although it will take longer time.

With the last paragraph, the author recognizes that this fixed percent reduction method takes long time to complete and suggested to accelerate during the final part  by increasing the reduction rate. The point is that he/she didn't mention HOW to! The argument seemed to be: don't worry! your current dose is now so small that you may reduce whatever you wish with no risks for symptoms 

Hi jeanne1987

I believe the way you cut the .5 mg tablets (.25, .125, .06125 .0363,...) left you with no choice. With tablet splitting, you do a taper whose only rational is the separation of a tablet into tiny equal parts. Most of the time this results in a taper pace way to fast. This is the reason why we do micro-taper, be it with dry cut or via liquid taper.

Now that you have taken your last dose 2 weeks ago and are feeling rough symptoms, you just wonder if you should up-dose and from there start liquid taper. I must confess I'm not a fan of up-dose nor of reinstate. I believe in holds, long holds if necessary. I believe our body has that capability to repair harms inflicted, from both outside and inside. This is by inheriting an evolution of millions of years where human kind has survived to become the marvelous mechanism it is today. Let it repair itself. We can certainly help by not interfering with its work and in parallele offer a full acceptance to the symptoms that might be unbearable at times. The unsettling symptoms are a sign that your body is fighting its way to be normal again in the absence of benzo. Have a look here to understand why you are healing.

Hope first windows will open soon for you.

Dear Jim,

Thanks for your thoughtful response. I just happened to see it now.

Since I wrote some subtle new symptoms have come up-- toxic inner vibrations especially when trying to sleep, ear pressure, extreme fatigue. I am a little concerned that with the unintended (because of ignorance) cold turkey from intermittent use since last year, plus the irregular dose throughout February and March, then finally the taper in April (the first week of which being horrendous with extreme head pressure), that is when I felt my sleep was ruined. Somehow, I am hoping that if I re-instate and stabilize then I would give my brain a chance to get sleep back and taper off?  I loathe the idea of re-instating myself...

I don't recall if you had any problems with insomnia but do you know if anyone on k got deep sleep back?

Thanks a million.

Hi jeanne1987

do you know if anyone on k got deep sleep back

MANY people reported that sleep comes back months after the last benzo dose. Slowly but it will be back. It seems that vitamins, herbs to drink do not help a lot. Overall know that using another drug to induce sleep might start another cycle of dependency and taper.

Somehow a buddie recently managed to sleep again being in withdrawal. Take a look: http://www.benzobuddies.org/forum/index.php?topic=202511.0

Have a good sleep back!

Hi Jeanne1987

As my previous reply was incomplete, my apologies. Here is the rest.

I am hoping that if I re-instate and stabilize then I would give my brain a chance to get sleep back and taper off?  I loathe the idea of re-instating myself...

Actually there are many many buddies, far too many   that are in your same situation. They underestimated the duration of the taper and somehow stopped too fast or just quit abruptly, thus raising a multitude of unsettling symptoms. And once they were destabilized in this way, many have reported that going back on their medications—especially if it had been longer than 3, 4 weeks since they’d stopped taking them—did not relieve the withdrawal symptoms. For some people, it seems that going back on their medications after an abrupt withdrawal can actually make problems worse, as can trying entirely new medications. After the drug is taken away, the body and brain begin to re-acclimate themselves to the new biochemical conditions when they are called again to tackle the again-introduced benzo. The newly initiated equilibrium vacillates and symptoms appear to be a way for them to shout out STOP!

I personally had one reinstatement. It occurred 2 days after the last dose. I believe the very short interruption when the last benzo was still lingering in my bloodstream was the reason why I managed to taper again with no symptoms when up-dosed.

Hi Jim,

Yeah, I've been reading a lot of posts and although some people have claimed that their sleep has improved, even in success stories, sometimes reading between the lines, it seems that they have not returned to having deep sleep like pre-benzo, especially for those who have been taking klonopin.

I want to be hopeful for recovery but it looks like I am being asked to bear this cross of being one with the elderly that I was taking care of. Six months ago, I was myself. Now, I am having a lot of the problems of the elderly at a very young age-- my episodic memory is shot ( I can still memorize some info, though), cannot associate things and coordinate info the way i used to, my vision is blurry, fatigue, movement is not smooth, confusion, can't tolerate some foods, emotion blunted, lack motivation, I feel like I'm just drifting, and many other subtle but present changes, sadly I can't even sit still, pray and just be, (oddly enough, except when I come to this website desperately seeking hope) and I am aware of my losses.  I want to be grateful and excited about what I still have but it's difficult.

I hope that this is going to change for the better but it makes complete sense to me, having studied some anatomy and physiology in my nursing courses and my first degree in occupational therapy that such an assault to the CNS would leave irreparable consequences. May I be proven wrong and be healed some time in the future, not just myself but you as well, all of us!

I wish to commend you, Jim for your unwavering dedication to assisting many people here, your optimism and astute mind is a gift.

I am thinking of 2 Scripture passages (studying the Word of God was my passion, now I am having difficulty with it but I know that the Word lives in in me.)

2Corinthians 12:10 "That is why, for Christ's sake, I delight in weaknesses, in insults, in hardships, in persecutions, in difficulties. For when I am weak, then I am strong."

Judges 6:14 <Then the LORD turned to him and said, "Go with the strength you have, and rescue Israel from the Midianites. I am sending you!">

Most grateful for your support and encouragement.

Hi jeanne1987

Thanks for your kind words. You made me feel happy.

I went thru some of the symptoms you mentioned. At a certain point my memory, cognition, mind clarity were so bad that my family suggested me to visit a specialist for Alzheimer/dementia disease.

After I took my last dose of benzo 8 months ago, everything slowly comes back. I worked in IT and have been able to come back 5 months later to write codes for Benzodiazepines Taper application. It was a simply unimaginable task just a few months earlier! During that period, certain days I was completely disoriented and lost in front of the computer and turned around and around for some basic things I usually had no problem with. Whether you are conscious or not, our body inexorably repairs itself and renews day after day. Nowadays I think I'm at about 60-70%. So I can confirm, as it actually happened to me, that your memory, cognition, concentration will come back and this already after a few months without benzo.

Wish you see soon the light at the end of the tunnel.