Help planning the end of my taper - completely burned out

[[Buddie]]

Hello everyone,

I would appreciate some perspective on my situation.

Brief background: I have had major depression since childhood. In May 2018, I was prescribed 2mg of clonazepam. Starting in October 2020, I began a crossover taper per the Ashton Manual and switched over to diazepam (40mg equivalent). After going down 1 mg about every two weeks, I am currently at 3mg. I began the taper because I wanted to start a certain treatment for depression, but benzodiazepines dampen the effect.

I am now completely burned out. I can barely take care of myself and feel utterly disconnected from myself, others, and the world. Every day I ruminate about how stupid, tired, forgetful, and empty I am. This has been the most traumatic experience of my life. I desperately want to reach zero so I can finally begin to heal, though the thought of maybe needing to wait another 6 months, or even another year, horrifies me. But knowing that I was in the healing phase, and being able to pursue the treatmetn for depression, would be such a relief.

Now that I am near zero, I am considering switching to tapering by 0.5mg diazepam every week (instead of 1mg every 2 weeks) - so 2.5mg, then 2mg, 1.5, 1.0, 0.5, 0. The Ashton Manual would recommend spending 1-2 weeks on each of these steps, preferably 2, but the thought of dragging myself through another 2-3 months is unbearable.

Is this just plain foolish? Am I letting my impatience cloud my judgment? Or is my plan difficult, but doable? I read that some people have regretted going as slow as they did. I don't believe this would be close to cold turkey or put my life in danger, but if there's a reasonable chance this pace could harm me I would definitely reconsider. More than anything else I just want to get it over.

Thank you very much for any feedback.

[[Buddie]]

Am I letting my impatience cloud my judgment?

Unfortunately, impatience seems a common symptom of benzo tapering. And this effect seems to be exacerbated by a rapid rate of tapering, which in turn causes feelings of greater impatience and continued rushing.

If you can barely take care of yourself, I suspect that you have tapered too quickly.

Healing does not begin once you're off the medicine; I've heard other taperers make similar statements to justify their rushed tapers and to give themselves hope that it will be worth their increased suffering to get to acute withdrawal (post tapering). I want to warn you that this is a myth.

The rewards of a rushed taper are only increased suffering, risks of protracted withdrawal symptoms, and other health complications. Please consider how benzo withdrawal occurs...

Benzo withdrawal symptoms indicate a dosage reduction that exceeds the body's capacity to quickly regenerate it's neurology. If you reduced at a rate that was matched by your body's regenerative capacity, you would never once experience a withdrawal symptom; people with high neuroplasticity have this experience all the time, getting off high doses in weeks or less. They typically don't join BB during this taper experience.

For those of us with limited neuroplasticity, we are expected to tolerate some discomfort but the safe and functional taperer has the opportunity to manage this discomfort by tapering slow enough that their body can keep up or catch up at regular intervals. With an appropriately slow taper, healing happens all the time; likely every single day.

There is no race to the finish with benzo tapering; there are no special benefits for overloading your body's repair capacity and suffering debilitating symptoms just to be rid of the medicine. This is not how neurological healing works, and it's not, in my experience, a safe or optimized approach. The neurological repair work takes as long as it takes and for rushed tapers this can drag on for many many months after entering acute.

I understand you're at 3mg and plotting a course to get to zero. No one can tell you how fast or how slow to go; however, I believe your body is telling you and has been telling you symptomatically, perhaps for many months. Are you willing to listen to your body and adjust your taper accordingly?

If I was in your position, and struggling as you describe, I would be holding my dose and waiting for my body to catch up on repairs. This may go against the overwhelming sense of urgency you're experiencing at this time; please consider that this sense of urgency is likely a withdrawal symptom. I strong urge you to prioritize stabilizing and regaining functionality before taking further reductions.

[[Buddie]]

Thank you very much for your reply. I appreciate your observation that the feeling of urgency may be a symptom of withdrawal in itself. This process has felt like a series of escalations, where the closer I get, the worse I feel and the greater my desire to finish becomes. I agree that it makes logical sense to slow down and taper based on my symptoms.

Subjectively though, it's a very tough pill to swallow. One of the few things that has been comforting is knowing "at least the taper will be done by X." I have been ruminating that "there is no point in doing anything or caring about anything" because no matter how stable I get beforehand, each taper step sends me into another tailspin. I think to myself, why try when two weeks from now all your efforts will certainly go up in smoke as you ride out another wave of symptoms? Pushing the end out even further just reinforces this feeling.

I was supposed to go down to 2.5mg tomorrow. I have been scared to do so, knowing that I am still suffering from 3mg. That should already have been all the evidence I needed to slow down. I now think that I will hold for a bit, though I fear that if I "wait for my body to recover," I will fall into depressed complacency and never get off of this drug. Once I stop setting dates and expectations, the months blur together. I know that's not very rational.

Thank you for helping me recognize and confront my impatience. I can tell I am struggling to accept your advice. I will do my best to listen to my symptoms and let them inform when I take the next step.

---

As a follow-up question, would you consider 0.5mg to be a "standard" last dose for diazepam in the community? Dr. Ashton lists 1mg in the manual, but while reading Benzo Buddies, I found 0.5 diazepam (or its equivalent) to be pretty common. I know it's different for everyone and you can't give specific advice, but is my understanding wildly off or anything?

[[Buddie]]

Thanks for receiving my feedback with such grace! I'm glad that I could help you to consider your situation.

The mental anguish that takes place while we taper is easily, I think, the most dangerous aspect of the taper; being unable to think clearly and rationally led me to make serious dosage mistakes on medical THC and this painful learning experience has given me a little advantage when tapering benzos. I have still rushed my benzo taper, multiple times, but I have been relatively quick to recognize my error and adjust; the prolonged agony of my THC overdose is still fresh in my mind.

We all learn through experience, and your description of a series of escalations is all too familiar to me. I think getting comfort from an intended taper end date is a form of self-torment; it sets us up to make poor tapering decisions trying stick with an outdated plan, because no plan survives first contact with biology! I personally use a series of day-to-day functionality goals (sleep, appetite, gentle exercise, etc), and I adjust my taper to meet these, not the other way around.

Cut-and-holds are, like you say, unpleasant waves; this is why some people go to the trouble to titrate daily with a scale or liquid. The lower you go in your diazepam tablets, the harder it is to take small and safe cuts. 3 -> 2.5mg is a 16% reduction; that's generally not considered a safe reduction and I doubt it will be comfortable. You may really struggle with these last few cuts, so I suggest giving yourself as much time to recover before hand as possible; let months blur together if you need. I suspect you have other things to live for, and if not, it's never too late to find some.

You will finish this medicine taper, I have NO doubt! You're so close to the end. I think it'd be better to walk off the medicine in six months feeling okay than waiting bedridden for six months after without any medicine to slow things down.

Dr. Heather Ashton dragged her patient through a linear taper, taking away 25%, 33% and 50% reductions every 1-2 weeks as they reached their final doses. You might also notice that she is very familiar with withdrawal symptoms and protracted withdrawal symptoms; to my mind, she is not a role model or presenting an ideal at-home taper. Dr. Ashton was running a clinic, where the goal is to rush patients in-and-out and try to send them out in better shape than they came in; that her clinic was trying to go slow was exemplary, but not ideal.

If you want to taper down to 0.5mg before jumping, I support this approach. But I would not use the very last sub-milligram dosage reductions to try to make up for rushing to this point; this happens all to often and I don't think it's much more than a placebo beyond 0.5mg.

You sound like you're going to get through this with increasing grace!
Let us know if you have further questions.
I hope to see you around the forum. I'll be praying for you. 

[[Buddie]]

I'm just posting an update to keep me grounded. It's hard for me to believe that since October 2020, I have gone down from 40 mg equivalent diazepam down to the mere 2 mg I'm on right now. I had hoped to be done months ago, but the reality of how tough the last steps are hit me like a truck.

Thankfully, I was able to use a compounding pharmacy to formulate 0.25mg capsules of diazepam. I feel it has been a good compromise between irregular pill cutters and overly complex methods like water titration.

Honestly, my brain is fried. I also suffer from ADHD and I've never felt more a slave to my phone and computer. I worry about the effects on my cognition. Before I learned about benzos and realized I needed to taper off of them, I knew I would need to go back to school or learn a new skill if I was going to support myself long-term. Now I struggle to make myself do much of anything. I'm lucky if I talk with a stranger once a week. My only real achievement lately is that I have been regularly walking 2 miles a day for a month - which is awesome, don't get me wrong. But I feel completely detached from the bright kid I was a decade ago. I read that I should expect some of these symptoms to get better with time, but at this point I'll believe it when I see it.

Looking ahead, assuming I stick to my current schedule (though I do slow down when needed now), I will reach 0.5mg by December. After another 2 weeks, I'll then "take the plunge" to 0mg, as Dr. Ashton recommends in her manual. I feel like it will be a rough time - dark days, cold nights, the worst of withdrawal. I'm scared, but it feels sort of manageable knowing the end isn't too far away even if I do need to slow down for an extra month or two.

I don't know what life will be like after all of this, or if my body and mind will be able to keep up. I think more than anything, I hope that one day I will be able to close my eyes and relax without feeling this primal restlessness always with me. That's my wish.

[[Buddie]]

Its good to see you again and congratulations on your progress!  I'm sorry to hear how small your life has become but it's good you're walking, its important to have a healthy body through this and you'll want that healthy body for when you recover and are ready to reclaim your life.

The primal restlessness left me when I recovered, I'm looking forward to when yours leaves as well. 

[[Buddie]]

Thank you, [...]. I'm glad to hear the symptom got better for you as well. I think I could be told a million times that yes, you will get better, and I'll still find a way to forget it/not believe it the next day.

I appreciate the positive encouragement.

[[Buddie]]

You're in the majority redapple, our brain only lets us see the negative while we're going through this, we need constant reassurance we'll get better, that's why we're here, to let you know you will.

[[Buddie]]

Hello all. I have been putting off an update for many weeks.

Just a week ago I went down to 0.5mg. I'm not sure how to feel about it. Mostly I haven't felt much of anything for months now. Right now I'm having a somewhat clear day, but this process has sunk me into depths of depression I didn't know I could reach. I guess I should be happy that I'm near the end of the taper. But I am afraid of what will come next, of how I will cope when I am recovering but no longer have a taper schedule to ground me. I am afraid of all the work I will need to do to recover. Before my taper I was already in a rough spot mentally and I feel like this process has only set me back. During the taper, my goals have been small: make it to the next day. Eat. Take a walk if you can. Soon I will need to challenge myself again and I can't see how I will possibly be up to the task. It took me weeks just to come here and write something.

People say it will get better. Better than it was during withdrawal, sure. But better than before? I don't know.

Dr. Ashton recommends you go directly from 0.5mg to 0, but I might do an intermediary step of 0.25mg just because. I don't see how it could hurt. In any case I will check back in later. Sorry that this was not a very happy update. I am grateful to have had a mentally clear enough day to write at all.

Until the next update, take care.

[[Buddie]]

Hi redapple, you mentioned that you wanted to start a certain treatment for depression. Can I ask you what that treatment is? Are you still aiming to start it?  I have read your posts and see that you are very determined. Please don’t worry that your world is small just now. When I see busy people who are rushing about in their frantic lives, they seem to be always complaining, wanting more etc. A small life is not a bad life. You are walking 2 miles a day, how wonderful, I wish I was that fit. I wish you every good wish for your happiness and health.