Psychiatrist modified Ashton taper

[[Ma...]]

I went to the shrink yesterday.  Trying to get of ativan, bad widrawal 9 years ago. He had me going down from 3 mg/day by .5mg a week.  When I got to 2 mg, I started to have tremors and a very high level of anxiety, pacing the floor.  Backed up to 2 1/2 and it didn't stop.  Went back to three.  Went online and found the group and the Ashton method. Makes sense to me.  Printed it out and showed it to him.  Said he would follow it with his own revisions.  He said I could go directly to Diazepam equalivalent from Ativan. Part of the reason is that New York State law only allows 4 mg of Ativan per day, and the state would consider adding diazepam as double dosing because it is similar.  He agrees witn the diazepam taper after that.  Any thoughts?

Also, he said according to his chart, 1mg Ativan = 5mg diazepam, not 10 like on the Ashton chart.

 

[[ly...]]

 

Taper Ativan more slowly and get as low as you can?  You may find that you can taper it all the way down.  Crossing over to V is not etched in stone.  Go as slow as you need to.  Many find Ashton too fast.

[[Up...]]

This typo

 

couldctly

 

makes it hard to understand what you are asking.

[[sk...]]

This typo

 

couldctly

 

makes it hard to understand what you are asking.

 

I'm guessing Cold Turkey...

[[ly...]]

 

 

I thought "could not cross"

[[sk...]]

Good point.  So many variables. 

[Guest [Le...]]

Also, he said according to his chart, 1mg Ativan = 5mg diazepam, not 10 like on the Ashton chart.

 

Whoa, be careful of this - based on my own recent experience with Ativan --> Valium, no way his chart is correct on this. I believe Ashton's chart is much closer, even though there may be no exact equivalent.

 

Be careful before you commit, because that's going to be a painful 50% drop in dosage, yikes!

[[sk...]]

Yeah, be super careful!  My pdoc said 1mg of xanax was 10mg valium.  Dr Ashton has it closer to .5mg of xanax is equal to 10mg valium.  My doc had me cross from 1.5mg xanax to 10mg valium in a matter of 2 weeks.  That was super hard.  Took me forever to get right again, but i stayed the course on 10mg Valium as that's all my pdoc would do.  I'm now dropping at a rate of 25% every 2 weeks, which is super aggressive... I've had a lot of up's and downs... A LOT.  Even though it's been hard, ugly, dirty, nasty, rough, rancid, everything in the book... by far anything else... IT'S BEEN WORTH IT! 

 

 

[[At...]]

I agree with skittles.  If you research V and Xanax (or Klonopin) the vast majority of sites will put it at 20:1 (20mg V to 1 mg X or K).

I've done my own modified version of Ashton.  It was pretty smooth sailing at the beginning, but some cuts hit hard.

I am assuming that as I get lower in dose that i will feel the cuts a lot more so I've been cutting a bit less.

Ashton does recommend some heavy cuts that I've modified by 1/2 for my comfort.

Slow and comfortable(as possible) is key.  You have nothing but time.

 

[[Ma...]]

Corrected the typo.  He did not think I needed to go to combination ativan/valium taper, but could just go directly to equivalent dosage of valium for ativan.  I have been researching, and found something that said the equivalent could range from 2mg to 10mg in the literature because it really has not been studied.  He pulled out a handy dandy equivalent chart out of his desk drawer and put me on 5 mg valium 3 times a day.  He is also worried about me becoming drowsy or losing coordination as I fell and fractured my pelvis in March. I am really worried, not sure he knows enough about addiction management.

[Guest [Le...]]

I have been researching, and found something that said the equivalent could range from 2mg to 10mg in the literature because it really has not been studied.  He pulled out a handy dandy equivalent chart out of his desk drawer and put me on 5 mg valium 3 times a day.

 

You may want to check with other BBs before you fill that script. If I had taken 5 mgs of Valium for 1 mg of Ativan I would have gone into acute WD.

 

You don't want to be caught with half a month's supply if you come up short and he can't correct it.

 

Good luck!

[[sk...]]

I kinda went through a rough time getting on Valium.  My pdoc pulled the same handy dandy paper out, and said 1mg of Xanax was equal to 10mg of Valium.  I was on 1.5mg Xanax.  Given that bit of info, i had to pull a taper while I crossed over.  It was hard as hell!  Dr Ashton's chart has Ativan recommended at 1mg for 10mg. 

 

http://www.benzo.org.uk/manual/bzcha01.htm#24

 

With that said, if your doctor will not help with that method, maybe you'd have to undergo a pretty aggressive taper first to get to the 15mg dosage.  Heck, depending on you, and everything you personally got going on, it may be a seamless transition.  It took me 2 weeks to get down to 10mg Valium from 1.5mg Xanax.  Then I dropped to 7.5mg Valium at the same time as my last .25mg Xanax.  3 days later I had to reinstate back at 10mg Valium to try to get right.  I got maybe 2 days of 'freedom' during that time, and dropped again to 7.5mg Valium, and i've been there for a few days. 

 

LeslieAsh has the right bit of info though.  Before you fill that script, first make sure you're committed to the taper plan.  It's super hard to go back.  Dr Ashton's methods are the only ones with proven results, as her success rate was i believe at or above 90% with minimal discomfort.  I take my valium at night time only, and none during the day due to it's half-life.  It seems to keep my symptoms only uncomfortable to rough.  I've had some rancid days, but mostly they are rough. 

 

I wish my pdoc would have used the other equivalencies per Dr Ashton, but looking back, and keeping things in a positive light, i'm not looking at it like a jump start.  Basically my pdoc gave me a giant shove towards success.  Was i scared?  Hell yeah!  Was it hard?  Hell yeah.  But did it kill me?  No.  Did i think i was going to die?  Yup. 

 

Sorry i'm super long winded.  I'm actually having a decent day today.  Long story short, if your doc won't accommodate your proposed plans, you can either do a direct taper from your dose, which is super hard, or buckle up and lean on all of us here.  I've heavily relied on people here for more than anyone thinks.  Inspiration goes a long ways!  Feel free to pm me or reach out if you need to vent, need an ear, or whatever.  You got thousands of people here for ya, thousands of people here that have walked down that dark road, and tons more walking this road with you. 

[[Gr...]]

Just chiming in on the Xanax to Valium ratio. I did a partial crossover with the 1mg Xanax : 10mg Valium ratio and for me that felt about right. Even Ashton said the equivalencies are approximate and vary from individual. That said, any crossover should be done a little at a time, maybe drop .25mg of the current benzo and add X amount of Valium. You could do the first step over using Ashton's equivalent. Then if that feels too strong as if you updosed, then on the second step you could add a bit less than Ashton's equivalent. Just get a slow feel for what is right for you.

(In hindsight, I think I should have crossed over completely, but I felt so fatigued by 15mg Valium I decided to taper off the remaining Xanax instead. It took a lot longer than I thought it would.)

[[sk...]]

Just chiming in on the Xanax to Valium ratio. I did a partial crossover with the 1mg Xanax : 10mg Valium ratio and for me that felt about right. Even Ashton said the equivalencies are approximate and vary from individual.

 

Oh I totally agree!  I fully believe that it really is individualized.  I was looking at your progress in your sig line... I wonder if the difference for your case was Xanax XR vs Xanax 'quick release'.  I could easily see that as a factor too.  I guess it all boils down to what the OP feels, sees, and is comfortable with.  It's awesome to have multiple resources to pull info from too. 

[[Ma...]]

Hi.  It's Ativan, not Xanax, but still a big change.  Unfortunately, a new law in New York says all scripts have to be faxed, and it was faxed and filled.  I took 1mg Ativan am. 1 mg Ativan pm, 5 mg Valium bedtime.  Trouble getting to sleep, took Atarax ( an antihistamine prescription he gave me that is also used for anxiety).  Woke up dizzy, blurry vision even with glasses, increased anxiety.  Really scared, used walker because of recent fall.  I have half a bottle of Ativan 1mg 4times a day left, due to direct taper I did last month that didn't work.  Added 1/2 Ativan pill .5mg, a little better.  I can do this for about 3 weeks, which could keep me sane.  Has anyone else experience this where psychiatrist used different equivalency tables, and would not give script for combination due to New York State Law?

The idea I proposed to him was to change to Valium (Diazepam) because of longer half life.  He agreed to that.  He also agreed to keep me on the Valium during the summer, and I would begin the total detox in October.  I booked a trip abroad before my fall in March, for  early September, and I could not go if I was having withdrawal symptoms.  These could last for many months, even with slow taper.  If I started October 1 with this doc or outpatient rehab, I would be better off doing it during fall and winter because we live in the land of lake effect snow in Western New York, and I could go into hibernation.  It's too late to cancel the trip not lose money, and it  gives me something to look forward to which helps with my depression issues.  I know this is a lot of info, but any thoughts?  Anybody living in upstate New York having these issues with a shrink with a different dosage chart and State Laws?

[[sk...]]

Hi.  It's Ativan, not Xanax, but still a big change.

 

I believe we both knew that, but were just talking about the equivalencies of Xanax due to your crossover statement, and we were talking about how it effects people differently.  I believe I also posted Dr Ashton's chart which shows her estimated Ativan change of 1mg Ativan to 10mg Valium.  As far as what dosage charts are concerned, and you'll hear tons of different people's stories, it really all depends on the doctor.  Reading some other posts, from what I can see, you're lucky to still have any Ativan, because someone said New York does not allow pdocs to give 2 benzo's and consider it double dosing. 

 

My story is similar to yours.  Like I said, my pdoc had no problem switching me to Valium, crossed me over, but at a way lower rate than Dr Ashton recommends.  There are a LOT of different charts out there, that many different pdocs go by.  My pdoc sounds like yours.  Mine put my Xanax at .5mg to 5mg Valium.  Dr Ashton shows that .5mg Xanax is equal to 10mg.  I was forced into a tough drop.  So long story short, you may have to endure the drop and the symptoms that come with it for a short while as your body adjusts to the longer acting benzo.  I can promise you it can be done, but it'll be hard.  So if you think that you want to cross over, and begin the sharp taper, then buckle up.  Here's a quick link that some doctors use too... It has Ativan 1mg equal to 5mg Valium.  http://emedicine.medscape.com/article/2172250-overview

 

Point being, there's a lot of charts out there that pdocs follow, and it really all depends on the pdoc, and how well you tolerate the change.  Maybe if you make the change, and a couple days later, you're fine.  Then you worried for nothing.  But should you have serious issues arise, maybe you can see your pdoc and let him/her know that you're not tolerating well, and provide other resources.

 

Best wishes, and good luck.

[[Ma...]]

Thanks.  Yes, leftover Ativan from last month godsend.  I have to stick with it for at least until my next appointment in 4 weeks.  I could possibly talk him into prescribing Valium 5 mg 4 times a day, which would give me an extra pill that I could cut in half and add to pm and bedtime dosage.  If I went to him right now He would not give me another prescription.  I will just have to tough it out for another month or so to let my body adjust.  Like skittles said, it is only the first day.  It's just frustrating being in a benzo withdrawal fog right now.  My husband had to do everything for me for 8 weeks while my fracture was healing.  I was starting to get up and around doing a little housework and gardening.  Now he is stuck again without any help.  He is 68 and should be just enjoying his retirement with the productive partner he married.  I'm going to try to get out in the garden this afternoon for a few hours, as the gardening really helps with anxiety.  I'm also going to try to go back to gentle yoga next week.  I know I HAVE to get off benzos and even later decrease my hig dosages of depression, or face another fall, which could really be catastrophic.  I am also dealing with going to a rheumatologist to address the osteoporosis, which also caused the pelvic fracture from a minor fall.  A fall caused by am dizziness from all the meds.  At 64, I am in such good health otherwise, i's really a terrible shame.  I wish nobody had EVER given me benzos, even if it meant dealing with anxiety in different ways and lifestyle change.  If you are younger, get off this stuff, no matter what it takes.  Once you are in your 60's you have normal cognitive decline exasperated by the long term benzo use which has pickled your brain.

[[Am...]]

Hi Marja. I am in Texas but I think I know exactly what you are talking about. When I first started seeing my pdoc, he told me he was only allowed to prescribe 4mg xanax (xanax is what I was on at the time) per day. I think Ativan is probably about the same dosage as xanax though of course it varies per person. I am sure these laws are not just state to state but the entire country. I know they have really cracked down on opiates/narcotics/controlled substances. You can't even get a refill on vicodin anymore, you have to turn in a new paper script to the drugstore every time and all your info goes into a national database. Benzos aren't quite as controlled yet, but I feel they will be soon the way the laws are going.

 

I never asked my pdoc about ashton, I was too scared he would just tell me no, which I am now sure he would have as I doubt he would be able to prescribe 2 benzos at once. IDK if he has heard of Ashton or done any research, he is as old as the hills lol.

I was told different things in my pdocs office, 3 days hold then cut, a week hold then cut dose in half, it was super confusing.

I knew he would not be much help and I am very impatient as taking this drug has hurt my marriage and family; so last week I decided to just be done. I know not everyone can manage to do that and stick with it. I am 10 days in and very much still feeling crappy and sick. It is very difficult knowing I could get more pills down the road - but I refuse to succumb to my weakness.

 

Hi.  It's Ativan, not Xanax, but still a big change.  Unfortunately, a new law in New York says all scripts have to be faxed, and it was faxed and filled.  I took 1mg Ativan am. 1 mg Ativan pm, 5 mg Valium bedtime.  Trouble getting to sleep, took Atarax ( an antihistamine prescription he gave me that is also used for anxiety).  Woke up dizzy, blurry vision even with glasses, increased anxiety.  Really scared, used walker because of recent fall.  I have half a bottle of Ativan 1mg 4times a day left, due to direct taper I did last month that didn't work.  Added 1/2 Ativan pill .5mg, a little better.  I can do this for about 3 weeks, which could keep me sane.  Has anyone else experience this where psychiatrist used different equivalency tables, and would not give script for combination due to New York State Law?

The idea I proposed to him was to change to Valium (Diazepam) because of longer half life.  He agreed to that.  He also agreed to keep me on the Valium during the summer, and I would begin the total detox in October.  I booked a trip abroad before my fall in March, for  early September, and I could not go if I was having withdrawal symptoms.  These could last for many months, even with slow taper.  If I started October 1 with this doc or outpatient rehab, I would be better off doing it during fall and winter because we live in the land of lake effect snow in Western New York, and I could go into hibernation.  It's too late to cancel the trip not lose money, and it  gives me something to look forward to which helps with my depression issues.  I know this is a lot of info, but any thoughts?  Anybody living in upstate New York having these issues with a shrink with a different dosage chart and State Laws?

[[ly...]]

 

 

Marja,  do you think that you could cut your extra tabs into quarters and take the equivalent of 2.75 (X and V combined) and then ease into 2.5 as your sxs permit?  Just a thought.

 

I'm from upstate (western NY) but have been in Virginia for 35yrs.  I am wondering if things are changing here.  I'm lucky because I have a big stash and my pdoc is still prescribing 1mg/day when I've been at .3125 for over 3 months - and he knows it.  I don't think he would ever force a taper.  I only have all this stuff in case he gets hit by a truck.

 

 

[[Ma...]]

That's something to consider.  Came in from gardening, worked up a good sweat.  Probably better for us than any drug out there.  Think I will take 5mg V +1/2 Mg Ativan tonight, and then try straight valium tomorrow. I got through today, the first day of my substitufion taper.  One day at a time.