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Deciding whether to do substitution or direct taper for K


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Hi there,

 

I posted before in the direct taper group, but then I consulted with both my psychiatrist and a specialized pharmacist who works with my GP, and they both recommended to start with the Ashton method...and now I feel confused.

 

I have been on a fluctuating dose of K for 15+ years. Early on I took it as needed, ie a few times a month. The past year I've been taking anywhere from 0 - 1.5mg /day, but more days than not taking 0.5mg at least. 1.5 only very rarely. I am currently stabilizing at 0.75 mg/day on advice from this group, and then want to begin a taper.

 

Ashton seems easy and well-trodden, but I keep seeing that especially with K the crossover is difficult, but I can't figure out why? Can anyone help me with this? I'm going to keep reading previous posts...I just feel really confused about which road to go down.

 

I want to do what's easiest to follow, and requires the least preparation. I do have access to compounding pharmacies that will make a liquid K preparation, but this still would be more trouble than just getting V at my local pharmacy.

 

So...to do direct or substitution...advice? Thanks so much !!!!  :smitten:

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First, its amazing to me that your doctor is familiar with Professor Ashton, kudos for finding someone knowledgeable.  Second, not everyone who tapers their original benzo will go the liquid route, most dry cut their way to freedom, it all depends on how your taper goes. 

 

I've not read that crossing from one benzo to Valium is anymore difficult than another, it mostly depends on the person not the drug.  With the Valium cross you may run into some sedation and depression but this seems to settle down for most people after a time.  Some people absolutely hate the feeling they get from Valium so they cross back to their original benzo but as I said, it's all individual. 

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Selkie

 

I totally understand where you're coming from. I was in the same position. I read a lot about people crossing over and had to make that decision for myself as well.

 

I can only offer you my personal reasoning and that is for one individual. I decided not to cross over. My reasons are: I don't know how I'll react to V and I might end up with worse wd than I currently have. Currently I'm coping fairly well. So better the devil I know than the devil I don't.

 

Secondly, if it doesn't work and I have to cross over back to K then I've lost so much time where I could've been done with it.

 

I started the tedious process of DMT a couple of months ago and yes it's annoying but I prepare my batch every 2 weeks and it's now part of the routine. I'd rather do that than compromise my stability on K.

 

That said, for all I know I could be the poster child for V cross over and it might even be better than K. Ultimately it's what you're prepared to take a chance on. I probably need to add that I had a very bad start to tapering that sent me into acute wd and I'm really scared I'll end up there again. That is also clouding my judgment.

 

I wish you the best with your decision.

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I am in a very similar situation to Jelly Baby. I taper K directly, though I have considered a V crossover, and I may consider it again at far lower doses but for now K tapering just makes my life that much easier. My goal is simple: less medicine; and direct tapering is getting me there as fast as I could hope for.

 

I suggest trying to taper K directly first. The main challenge is that the drug is so potent. A suggested jumping dose for K is 0.025mg. It's hard to get there comfortably with insurance covered tablets and a pill splitter, even though in some places you can get OD tablets as small as 0.125mg. However, pill splitting can be a place to start if you can get prescribed small enough pills and you get a decent pill splitter; I like the aluminum ones.

 

I use tablets and a pharmacy compounded liquid in a liquid/tablet hybrid DMT; I taper a little medicine every day, and this has significantly reduced my withdrawal symptoms. There is a learning curve to do something like this, but we will help you in any way that we can.

 

The biggest question in my mind is: how supportive is your doctor in prescribing what you need, as you need it, for a patient-led slow taper? If they're going to muscle the taper to their timetable, restrict the pills, etc, then I would keep them in the dark, just collect my script and do a direct K taper; doctor-led tapers are too dangerous in my opinion. But if they're amenable to patient-led tapering, then potential doors open to pharmacy compounding liquid K or gradual step-wise crossovers to something like diazepam which is less potent and longer acting than clonazepam. It's nice to have options.

 

Whatever you decide, I suggest going slowly. If necessary, a slow step-wise crossover. A slow reduction schedule. No deadlines. 15 years is a long time to become reliant on a medicine; the body and mind yield most comfortably to a gentle transition, in my experience.

Let us know any way we can help you.  :smitten:

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Thanks so much again to all of you for your generous replies!!!

 

What you say about "the devil you know" makes a lot of sense, I think that's why I started rethinking switching to V - I don't know what it will do, maybe it will be easier but maybe it will make me feel worse? I guess it would be pretty easy to switch back if it did end up making me feel worse. But also making the switch seems to really take time without even reducing at all, and even though I'm prepared to go as slow as it takes, it feels kind of like a waste of time to spend ~a month just switching to an eq. dose of a different med.

 

My doctors are all very supportive and I think would prescribe supportively - when we discussed it they said I could do Ashton or I could do direct. They were a little bit misinformed about how fast I should go if I did direct, but I'm pretty sure they'd be absolutely fine with me going slower.

 

I do want to make it easiest on myself in terms of math and preparation - I find the reduction schedule and then how to make the formulas out of my K pills really confusing, which is why I looked into compounding.

 

@slownsteady - I would love to hear more about how you're doing your taper! My partner is better at math than me (I truly am abysmal lol) and has offered to help me figure it out, but it still feels really daunting! Maybe it's the kind of thing that would make more sense when I start doing it.

 

@jelly baby, same to you I'd love to hear about how you make your dosages every 2 weeks!

 

@pamster, thanks for your insight that you've not heard any benzo > V is any worse, that's really helpful to hear!

 

Thanks again to all of you, it's so so helpful to have found this community, it makes it feel way less scary that we're all going through this somewhat together. I'm really scared of so many parts of it, but I am so glad to have people to talk to.  :smitten:

 

 

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Selkie

 

I'm glad you feel less scary. I totally understand the maths thing - I suck at it too and my husband helps me as well. The great thing about the forum is you also have people to run your numbers by if you're not sure. But having a partner that can support you and do the maths is invaluable.

 

I'm using Bob07's method to make my own capsules https://benzodrytapermath.com/

 

His spreadsheet calculates a month's worth of capsules, but I only make 2 weeks at a time to see how my body responds and then I can adjust my taper rate if I need to.

 

It will serve you well to look at both dry and liquid tapering and look at the pros and cons before deciding on a specific method.

 

I think most members here are going the liquid route.

 

I chose Bob's method because I struggled to understand the liquid maths and Bob's website had videos that I could follow step by step. (If you're seriously considering the method I'm using, I'm happy to discuss futher). However, since I started my taper, there have been a lot of posts and explanations on liquid tapering which I believe make it easier to understand.

 

You are asking the right questions and you are educating yourself on the process before just jumping in. That is a very sound approach!

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My doctors are all very supportive and I think would prescribe supportively - when we discussed it they said I could do Ashton or I could do direct. They were a little bit misinformed about how fast I should go if I did direct, but I'm pretty sure they'd be absolutely fine with me going slower.

 

I do want to make it easiest on myself in terms of math and preparation - I find the reduction schedule and then how to make the formulas out of my K pills really confusing, which is why I looked into compounding.

 

@slownsteady - I would love to hear more about how you're doing your taper! My partner is better at math than me (I truly am abysmal lol) and has offered to help me figure it out, but it still feels really daunting! Maybe it's the kind of thing that would make more sense when I start doing it.

 

I'm really glad to hear your doctors are so supportive! That's really great news.

 

My personal taper notes are in my signature (and here). I also share an instructional there on how I generate my DMT schedule using an online form; the same form works for dry as well as liquid tapering. People keep telling me I'm good at math, but I'm really not. I've designed my taper approach to make the math as simple as possible for me. For example, my liquid is 0.125mg/ml; this is so that 1ml replaces 1/4 of my 0.5mg tablets (0.5mg / 4 = 0.125mg), which is the smallest I can cut them with my beloved aluminum pill splitter.

 

I only taper 1/4 tablet at a time by replacing it with 1ml of liquid, and I follow my online generated DMT schedule to reduce the liquid dose; the rest of my dose/doses I take as tablets.

 

Today I am at 0.70ml of liquid, so I know I only have 70% of my recent 1/4 tablet-to-liquid swap remaining. I'm currently reducing by 6%/14 days, which at my dose is 0.04ml/day and takes about 26 days to eliminate 1/4 tablet. Then I cut out another 1/4 tablet, replace it with 1ml liquid, and taper onward!

 

Drawing my liquid dose with a 1ml syringe from a medicine bottle with a push-in syringe adapter is incredibly easy. No mixing, no math. I just read my printed schedule, draw the dose, dose, and put things away. I like my taper process.

 

My liquid can be made with tablets, I've done that successfully and I describe how I've done it in my notes. I'm currently using a pharmacy compounded mixture very similar to my home-made liquid, only it's made with pure clonazepam powder, pure ethanol, and diluted with distilled water to 30% ethanol by volume. Because I use less than 1ml a day, a 35ml bottle that costs $35 with shipping lasts a month or two; cost, consistency and convenience have had me using the compounded liquid for about two months now and I plan to continue.

 

Not all compounding pharmacies are created equal; I suggest calling around and seeing what options are available before asking your doctor for a script, if you decide to go the compounding route. If your in MA, ME, NH, CT or FL, I can suggest a really good pharmacy that will mail the compounded medicine to your doorstep.

Let me know if you have other questions.  :smitten:

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Thanks so much for the support everyone. I have decided to try the substitution with V method and just see how it feels. I'm just on the very first step, taking 5mg V & .125 K at bedtime, and .375 K in the morning. It's only been about 3 days, but I don't feel any different so far.

 

The main reason I chose this method is ease - I would have been able to access compounded K, but it would mean a lot more planning as the medication would have to be shipped. I won't mind doing this if the V feels bad, but if I don't react badly to it, it's just so much easier to get the V tablets from my corner pharmacy. It's also easier on my brain to just lower by 1mg at a time as per Ashton, once I switch over.

 

The other reason I chose to try the V - and this is more for people who might be reading this later considering which to choose - is a kind of symbolic/emotional reason that occurred to me when I was talking it all through with my partner: I have been taking K since I was a teenager, and have a strong emotional attachment to it. Especially since I was taking more when I feel anxious/overwhelmed/depressed etc, the taste of the tablet was instantly soothing to me. I feel so psychologically attached to the tablets themselves, and I think one of the hardest parts of getting off of this med will be not being able to turn to it to "rescue" me. But I also want to be done with it so badly. So even though V is still a benzo, once I've switched over, I will no longer be taking clonazepam , which I think in itself will feel freeing and like an accomplishment. And having a pill that is solely for the purpose of tapering feels helpful too - like, this new pill exists to help me stop taking benzos. I guess it adds a feeling of purpose to the whole thing. Of course, all of this is only good insofar as I tolerate the V, but for me it's a big incentive to try it.

 

Again, thanks for all your input, very glad to have found you and hear all of your wisdom and experiences.

 

:smitten::)

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Thanks for the update Selkie.

 

Good to hear the cross over is going well. I think you've made an excellent choice. Thank you for sharing your decision and reasons with us so others can learn from it too.

 

I'm looking forward to follow your journey!

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Thank you for this update selkie (I love your user name btw).

 

Your reasons make so much sense; I think it's SO important to ascribe positive meaning to the medicines we're taking, even if we're trying to stop taking them. If you can tolerate V, and ascribe the meaning that this is your slow path to freedom, I think that could go a long way to helping you stay the course.

 

My only suggestion is to remember that skill-building is the other leg of tapering, and equally important for stabilizing and functioning without these drugs. Since you've relied on clonazepam for so long, you may find a significant need to develop mentally and emotionally, specifically in areas of life where we need to "calm down".

 

I suggest minimizing distracting coping strategies as much as possible, and with the help of a therapist or whatever suits you, paying attention to where and when you need help calming down, and learn those skills. In my opinion this skill-building is best done during tapering, so that you can truly enjoy that freedom when you walk off the medication for good.

 

I hope you'll continue to share your brave journey with us.

:smitten:

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Thank you so much for these lovely replies.

 

slownsteady,  you're absolutely right about skill-building, it's so important and it was what I needed all along, long before I got on these drugs. Having always had the escape hatch of a pill (or two, etc) that will be sure to calm me down has certainly kept me from learning those skills.

 

I actually enrolled in a mindfulness cognitive therapy course specifically for depression and anxiety that starts this week - it's run by an MD and a social worker, and my psychiatrist recommended the centre that runs it. So I'm optimistic that that will help a lot, as long as I steer the course and do all the homework and practices, which I think I'll be pretty motivated to do. I'll definitely have to work on minimizing distraction though, or at least choosing healthier ones when the need does arise.

 

Thanks for listening and sharing !!!  :smitten:

 

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Thank you so much for these lovely replies.

 

slownsteady,  you're absolutely right about skill-building, it's so important and it was what I needed all along, long before I got on these drugs. Having always had the escape hatch of a pill (or two, etc) that will be sure to calm me down has certainly kept me from learning those skills.

 

I actually enrolled in a mindfulness cognitive therapy course specifically for depression and anxiety that starts this week - it's run by an MD and a social worker, and my psychiatrist recommended the centre that runs it. So I'm optimistic that that will help a lot, as long as I steer the course and do all the homework and practices, which I think I'll be pretty motivated to do. I'll definitely have to work on minimizing distraction though, or at least choosing healthier ones when the need does arise.

 

Thanks for listening and sharing !!!  :smitten:

 

Wonderful. I was recently using an app to restart my meditation practice (it's called Atom on Android), and it is based on how to build strong habits; one of the key lessons was about minimizing the need for motivation by using triggering events (something that you already are in the habit of doing to trigger the new habit), making the new habit as easy and simple as possible, and celebrating every small success. I found this information very helpful because my "can do" motivation always fades out after an initial rush, and I'm finding that by relying less on motivation I can more easily stick to my new habits (like meditation).

 

Good luck! I'm wishing you all the best with this mindfulness program.

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