Ashton manual math opinion/thoughts

[[Ma...]]

I keep seeing the recommendation of no more than 5-10% every 10-14 days on here but this seems to be at odds with the Ashton manual once you get to lower doses.  I’m currently at 0.7 mg of Clonazepam, which would equate to 14 mg Valium.  According to that schedule, I would go from 14 to 12 to 10, and then decrease by 1 mg increments from there if I was on Valium.  This is much more than 10% for most of the steps but I have to believe it has worked for many, because many people have gotten off benzos using her schedule.  Just curious about people’s thoughts… 

[[he...]]

Hi @[Ma...],

Because Ashton is way too fast for many of us. A hyperbolic taper has been proven to be easier to tolerate. So an Ashton taper may work well in the beginning until your percent cuts become greater than your body can keep up with. The Benzodiazepine Information Coalition recommendation is actually 5 to 10% every month, quite a bit slower than the 5 to 10% every 10 to 14 days recommended here. Just listen to your body and go at a speed you can tolerate. You will know if it's too fast.

[[Ma...]]

31 minutes ago, [[h...] said:

Hi @[Ma...],

Because Ashton is way too fast for many of us. A hyperbolic taper has been proven to be easier to tolerate. So an Ashton taper may work well in the beginning until your percent cuts become greater than your body can keep up with. The Benzodiazepine Information Coalition recommendation is actually 5 to 10% every month, quite a bit slower than the 5 to 10% every 10 to 14 days recommended here. Just listen to your body and go at a speed you can tolerate. You will know if it's too fast.

I think the problem and the frustrating part for me is you’ll also hear people say the Ashton method is way too slow.  I just find it frustrating there aren’t controlled studies that address this.  It goes hand in hand with the lack of medical knowledge on benzo tapering.  I know everyone is different and of course I’ll listen to my body, it would just be nice to see some data.  Sorry for the vent.

[[M....]]

Hi, Mattwahoo. First, what a great observation! The hyperbolic tapering schedule explained by “hereforhelp” is pretty well substantiated by the recent research by Mark Horowitz and David Taylor. (I think Horowitz once even posited that linear tapering may have originally seemed appealing because researchers were looking at how the actions of psychiatric drugs behave on logarithmic scales - but those scales can mislead us into seeing a linear relationship that isn’t really there.) Anyway, Horowitz and Taylor both advocate for a hyperbolic taper in a handful of peer reviewed papers if you want to check those out. Your question points to the need for a good, comprehensive literature review on benzo tapering research!

[[or...]]

1 hour ago, [[M...] said:

I think the problem and the frustrating part for me is you’ll also hear people say the Ashton method is way too slow.  I just find it frustrating there aren’t controlled studies that address this.  It goes hand in hand with the lack of medical knowledge on benzo tapering.  I know everyone is different and of course I’ll listen to my body, it would just be nice to see some data.  Sorry for the vent.

I think it's safe to say that many of us get frustrated because there just isn't enough data on benzos, at least not out in the open.  It's better than it use to be though, so maybe we have some ground-breakers here on the forum that will carry on what we are learning right here.  From real people's experiences.  The internet is a great tool to get the word out.  A lot of people like on Youtube, are jumping on the bandwagon, because the word is getting out.  Maybe we are part of the pioneers and sort of leading the way.  I feel I'm actually doing one of the most important things I've ever done, and at least a few of my friends and family are watching   I think this is a pretty amazing forum, I don't know of another like it, at all.

[[da...]]

Everybody is different, and people feel different things on different days. When I was tapering, some days I would go fast, and other days I would go slow, and sometimes I would completely hold. There is no hard and fast rule. Keep pushing forward to zero, and let your body and symptoms guide you. 

[[or...]]

21 hours ago, [[M...] said:

Hi, Mattwahoo. First, what a great observation! The hyperbolic tapering schedule explained by “hereforhelp” is pretty well substantiated by the recent research by Mark Horowitz and David Taylor. (I think Horowitz once even posited that linear tapering may have originally seemed appealing because researchers were looking at how the actions of psychiatric drugs behave on logarithmic scales - but those scales can mislead us into seeing a linear relationship that isn’t really there.) Anyway, Horowitz and Taylor both advocate for a hyperbolic taper in a handful of peer reviewed papers if you want to check those out. Your question points to the need for a good, comprehensive literature review on benzo tapering research!

Great that you understand it, I couldn't when I saw it a few months ago.  I think I'll take a look at @[he...] link above and see if it makes more sense to me now that at least some of the fog has lifted

[[or...]]

@[Ma...]  I do agree that the Ashton schedule is too big/fast at the lower doses. At 5 mgs, I had to slow waaaaay down and eventually go to a DLMT (daily liquid microtaper) just to keep making progress towards zero. I think everyone's quite different and we should regard Ashton as a general guideline, not the gospel. In essence, we all have to craft our own tapers. 

Good luck,

 

Katz

[[or...]]

23 hours ago, [[h...] said:

Hi @[Ma...],

Because Ashton is way too fast for many of us. A hyperbolic taper has been proven to be easier to tolerate. So an Ashton taper may work well in the beginning until your percent cuts become greater than your body can keep up with. The Benzodiazepine Information Coalition recommendation is actually 5 to 10% every month, quite a bit slower than the 5 to 10% every 10 to 14 days recommended here. Just listen to your body and go at a speed you can tolerate. You will know if it's too fast.

hey @[he...]

I want to try and learn about the Hyperbolic Taper now that my brain is less cluttered, but guess what, that Witt-Doerring dude still confuses me on his video I tried to "get" back when??  Isn't there something I can look at that is more for someone less educated like me?  More simple terms?  Like right now, for 5 months I tapered and held 6% per month, same 3% each 2 weeks, give or take a day, or two, til I feel stable.  At what point would I start leveling out the doses.  I just need a really down to Earth guide to follow.  I don't remember Horowitz video, but I think I had trouble with that one too   I'll go look for it though and have it handy

 

Ok, wait a minute, isn't by doing less of a taper the same as updosing?  Is Horowitz saying that you actually cut more to begin with, then taper less?  So if I am understanding him, and W-Doerring, Let's say I am taper 6% of my 1 mg (which "is" what I'm doing) until I get down to less than half my 1 mg tablet and hold for a time, then start tapering less than my 6% ( a month) isn't that just like updosing?  Somebody correct me if I'm wrong.  So if I were to switch from my 3% this week, next week only taper 2 or 1%?? 

[[Li...]]

A point of clarification … the 5-10% reduction every month calculated using the current (not the original) dose reduction regimen suggested by the Benzodiazepine Information Coalition, The Withdrawal Project, and Surviving Antidepressants results in an exponential taper not a hyperbolic taper.   Hyperbolic tapers are calculated in a different (more complicated) way.  However, the good news is that exponential reduction regimens approximate hyperbolic reduction regimens reasonably well.

Here’s a video featuring Dr. Horowitz that explains hyperbolic versus linear and exponential tapering, starting around the 22:15m mark:

What We Know About Safely Stopping Benzodiazepines from Research
Mark Horowitz, MBBS, PhD
Sponsored by the Benzo Warrior Community on March 12, 2023

 

 

[[or...]]

Where's that crying smiley when I need it, lol!  I was just watching that very video, but, I will go tune in on that "time" you @[Li...] gave us and listen.  Did you see my post yet?  Am I right in thinking the hyperbolic is like an updose, or am I still to froggy, I mean foggy thanks for you help though, I really want to understand this because my little 1 mg is look pretty puny at 5 months, and I'm just tapering 6% per month Denise

[[Li...]]

Hello @[or...]! If you are calculating your monthly 6% reductions based on your original dose of 1mg, you are implementing a linear taper.  If you are calculating your monthly 6% reductions based on the previous month’s dose you are implementing an exponential taper.  Neither one results in an updose.  I suspect this is probably as clear as mud. Perhaps this explanation from The Withdrawal Project will help:

Psychiatric Drug Taper Rates: A Review and Discussion | The Withdrawal Project
https://withdrawal.theinnercompass.org/learn/psychiatric-drug-taper-rates-review-and-discussion

Read the section titled, “Is tapering at 5-10% per month of the original dose really so different from tapering at 5-10% per month of each previous month’s dose?” then look at the chart that compares Jack’s linear taper to Jill’s exponential taper.

 

[[or...]]

 Hi and thank you @[Li...] ,

I don't know why I continue to "not" quite get it, but I think, you said it for me.  I go by weight, so my tablet average weight is .170.  Maybe I am really tapering the hard way and don't realize it but it's working.  Ok, so I take the tablet, and each time I taper I go for the next weight but just subtracting .003. I keep a little journal that looks like this (also on About me):

8/02/23   .120

8/18/23   .117

next cut will be .114

I do think I am doing exponential taper, as I do cut the same amount, but from previous dose??

I'll go and look at your link now, if I can get this solidly wrapped around my brain, maybe I can somehow end up doing the hyperbolic.  I just want to be on the best track I can be one   I'm doing ok so far, and only had the 1 mg to deal with but I took it 35 years.  I must have been in Tolerance wd for years as well.  I may sound worried but I'm not, not since I've gotten to know BB and it's people, not afraid, or into unrealistic expectations, healing yes, amount of??, well I'll just be grateful for any increase in quality of life Denise PS I'll come back after I read about Jack and Jill, who knew those kids had to taper benzos

 

 

[[or...]]

Ok, the site is overwhelming for me still, and it didn't have anything, according to my search, on Hyperbolic taper.  Also @[Li...] I think the site is amazing, I did read a little and it does contain a ton of info.  

Then I started searching for an online calculator for a Hyperbolic Taper and struck out.  There seems to be a couple but they won't calculate for Benzos, just anti-depressants, and one other type I can't think of now.

I just wonder if there is anyone here that has used the method because it sounds so promising.  It must be something rather new, I'm just guessing though.  Anyway, thank you again for trying to help me.  I'm fine for now just doing my exponential taper, and I'll keep listening to the Horowitz vid you gave me.  It's not the one I had seen earlier so I really appreciate trying this one to see if I can figure it out Denise

[[jo...]]

11 hours ago, [[o...] said:

 Hi and thank you @[Li...] ,

I don't know why I continue to "not" quite get it, but I think, you said it for me.  I go by weight, so my tablet average weight is .170.  Maybe I am really tapering the hard way and don't realize it but it's working.  Ok, so I take the tablet, and each time I taper I go for the next weight but just subtracting .003. I keep a little journal that looks like this (also on About me):

8/02/23   .120

8/18/23   .117

next cut will be .114

I do think I am doing exponential taper, as I do cut the same amount, but from previous dose??

I'll go and look at your link now, if I can get this solidly wrapped around my brain, maybe I can somehow end up doing the hyperbolic.  I just want to be on the best track I can be one   I'm doing ok so far, and only had the 1 mg to deal with but I took it 35 years.  I must have been in Tolerance wd for years as well.  I may sound worried but I'm not, not since I've gotten to know BB and it's people, not afraid, or into unrealistic expectations, healing yes, amount of??, well I'll just be grateful for any increase in quality of life Denise PS I'll come back after I read about Jack and Jill, who knew those kids had to taper benzos

Hi oregonlady,

No, you are doing a linear taper because each step is the same, namely 0.003.
With an exponential taper the steps become smaller as you are going downwards, so when your dose will be 0.060 the step will be half of 0.003 which is 0.0015.

I will try to explain how you can calculate your doses yourself. You need a simple calculator for this.

When you multiply your first dose, which is 120, by 0.975 you get 117 which is your second dose.
The third dose you would get  by multiplying the second dose, which is 117, again by 0.975 which gives 114.075
The fourth dose you would get by multiplying the third dose, which is 114.075, again by 0.975 which gives 111.223
The fifth dose you would get by multiplying the fourth dose, which is 111.223 again by 0.975 which gives 108.442

And so on.

[[dj...]]

I want to chime in here because this is a discussion I definitely needed to read.

I watched the video posted by @[Li...] and it was very helpful. So thank you, @[Li...] 

I am currently doing a linear liquid taper. My goal is to go down in 1ml increments (out of a 200ml water solution) until I am at 0.07mg out of the 1mg I am taking. (ending at 0.93mg daily, taken in two equal doses)

 I think I will then hold for a week (to let my brain catch up and see how my symptoms are doing), then begin the taper again. At that point, I believe I’ll try to do the exponential taper, but I want to be clear on the math. Does this mean that I’ll be trying to go 7% down from 0.93mg? And will this work without weighing the pills (I crush them in a stainless steel pestle and mortar currently)? It seems like working from a liquid solution is easiest to me, but perhaps I’m missing something…

Thanks for any and all help/advice/suggestions here 

[[Li...]]

You’re most welcome, @[dj...] I’m delighted you found the Horowitz video helpful.  Indeed, I hope your post will encourage more members and guests to view it.

My sense is there is currently considerable confusion in the benzodiazepine withdrawal community writ large (i.e. not just here at BenzoBuddies but in other online support communitie as well) about hyperbolic versus exponential versus linear tapering.  Many individuals seem to think hyperbolic tapering is the same as exponential tapering (it isn’t); there also seems to be a misunderstanding that hyperbolic tapering has been proven to be a superior approach via research studies involving human subjects (it hasn’t - at this point it is a largely untested hypothesis, albeit a promising and compelling one; the good news is research is underway in the UK with antipsychotics and in Australia with antidepressants).  

Re: your request for feedback regarding your taper plan …

Here are two comments for your consideration and two questions:

(1) Holding your dose constant for at least a week after you finish the first stage of your taper from 1mg to 0.93mg is a wise move on your part imo.  One of the downsides of daily microtapering is that it does not provide a clear read of what taper rate a given individual can tolerate.  Per Horowitz and Taylor (2019):

“… micro­tapering presents the possibility of cumulative withdrawal effects being super­ imposed on one another. This process would make it difficult to establish which reduction (or set of reductions) was responsible for the symptoms experienced.“

Adding a hold after a reduction (or series of reductions) allows withdrawal effects to fully emerge and stabilize before the next reduction is made. 

(2) If you wish to change from linear to exponential reductions for the next stage of your taper using a 7% per month taper rate, you would reduce your current dose of 0.93mg (not your original starting dose of 1mg) by 7%.

So, your target ending dose for the next month would be 93% of 0.93mg or 0.8649mg.   If all goes well and you decide to continue making exponential reductions at a taper rate of 7% per month, your target ending dose for the next month would be 93% of 0.8649mg or 0.8043mg.

(3) Can you help us understand what you mean by ‘‘will this work without weighing pills’?

(4) Do you have your own taper planning thread?  If not, might I encourage you to create one so we can address your unique-to-you taper questions there?  

[[jo...]]

@[Li...]

Thank you for the video.

I have watched it, at least globally, and what I find interesting and important is that in the "slow diazepam reduction" scheme that he gives at 42:22 the taper from 4 mg to 0 mg goes linear, so not hyperbolic or exponential.

[[Li...]]

You’re welcome @[jo...] Thank you for making the effort to watch the video.  It’s quite interesting, isn’t it?

Once you reach a low enough dose, the dose-effect (receptor occupancy) curve for diazepam becomes less steep.  Horowitz’s hypothesis is that you can increase the taper rate at that point because the reductions will have less of an effect.  Where this point occurs will vary by individual and benzodiazepine.  As Horowitz emphasizes in the video, taper rate should always be guided by how the individual responds to reductions.  Per the last bullet point on the “Exponential Tapering” slide:   

“One advantage of using a hyperbolic regimen is that exponential regimens ‘never end’ (e.g. get smaller and smaller but never reach zero) whereas hyperbolic regimens have a clear end point - where the changes in effect on the target receptors is less than the size that has been previously tolerated you can go to zero.”

 

[[or...]]

On 20/08/2023 at 08:31, [[d...] said:

I want to chime in here because this is a discussion I definitely needed to read.

I watched the video posted by @[Li...] and it was very helpful. So thank you, @[Li...] 

I am currently doing a linear liquid taper. My goal is to go down in 1ml increments (out of a 200ml water solution) until I am at 0.07mg out of the 1mg I am taking. (ending at 0.93mg daily, taken in two equal doses)

 I think I will then hold for a week (to let my brain catch up and see how my symptoms are doing), then begin the taper again. At that point, I believe I’ll try to do the exponential taper, but I want to be clear on the math. Does this mean that I’ll be trying to go 7% down from 0.93mg? And will this work without weighing the pills (I crush them in a stainless steel pestle and mortar currently)? It seems like working from a liquid solution is easiest to me, but perhaps I’m missing something…

Thanks for any and all help/advice/suggestions here 

Hi @[dj...] wondering how you are doing with the Hyperbolic?  I want to do this, but am having a hard time figuring what is different about it than the taper I am doing now.  I am doing 6% total a month of my 1mg of Clonazepam.  But, I do 3% every 2 weeks which probably would need to change and hold a total of 6% cut per month.  That's what I'm a bit scared to do, but I could maybe try it.  I've done another post for myself on it if you want to take a look.

I wanted to do this 5 months ago but the videos were too overwhelming for my benzo brain, but now, since some fog has lifted, I finally grasped the chart which amazed me my brain is working better already, I think, lol!  Anyway, here's the thread I started this a.m. since I was awake at 2 a.m. with race-brain Denise

 

[[Ma...]]

I think the bottom line is to just listen to your body.  We’ve all been on different doses of different benzos for different reasons for different amounts of time and with different psychiatric diagnoses and different life stressors.  In a nutshell: No one taper plan is going to work for everyone.  I’m going faster than what the Ashton manual recommends.  Lots of others need to go slower.  I may need to change and go slower, but I’ll cross that bridge when I come to it.  Do whatever is working for you and allows you to live your best life while you’re doing it.