How to switch to Hyperbolic Taper?

[[or...]]

Edit:  Please see Libertas reply before you bother reading any of my info.  Seems there's been some changes to what a Hyperbolic taper is and what it isn't.  I posted before I knew the new info but @[Li...] caught it

Here's a clip "attached" below

 

 

I just found this @[Li...] (post which was so understandable for me, link below) as I am interested in the Hyperbolic Taper, but have been on a 6% per month (3% every 2 weeks, give or take according to sxs) for 5 months, which is working great for me. 

I am tapering from 1mg Clonazepam.  I can see how fast the time is flying by for me, so I'm wondering if maybe the Hyperbolic Taper could be best for me to try (future-tripping over jump-off percent), but it's been hard for me to figure out how to switch to it as I don't fully understand Horowitz teaching, and can't stick with and learn from Witt-Doerring video either.

I see how the diagram goes down similar to a child's Slide, but the numbers are difficult for me to figure.  Can we talk a little about it here?  Anyone else is welcome to chime in as well, I just got a lot out of your reply so wanted to be sure to try and yack with you about it Thanks much, Denise

 

 

[[or...]]

Now something finally sunk in, and it happened when I looked at this chart again(please see more of my info below chart). 

This chart is based on , and I'll quote,

"The following shows a HYPERBOLIC taper of 10% every 4 weeks. 

This shows tapering from 100mg to 0mg, but the curve would be the same for any starting dose".

 

If I am understanding this correctly, so far, every step in the "stairway" is 4 weeks hold.  This one is at a 10% cut though and that's too steep for me, I'm already doing a 6% per month, but holding 3% each two weeks approx. depending on wd sxs.  So I would need to figure out my own numbers on the "stairway"  I think I am getting it finally but could really use some help just to confirm that.

Also, why on Earth would they say 100mg, is there such a thing as a 100 mg benzo?  I suppose there must be, man, I'm only dealing with this 1 mg of Clonazepam and so I would figure minus 6% per month.  I think I can do that, what does anyone think out there? Denise

 

[[or...]]

have I lost my one, remaining marble, or am I already doing a Hyperbolic Taper?? I think I'm missing something Ok, it just dawned on me I could still do 3% each 2 weeks, approx.  It still ends up 6% per month on the chart I would draw for myself. I still don't see the difference in the Hyperbolic and what I'm doing now though Denise

[[Li...]]

 

Greetings, @[or...] I’m glad you started a thread about hyperbolic tapering.  As I’ve mentioned in previous posts, there is considerable confusion in this community and others about this topic.

In a nutshell …

If you are reducing your dose 6% a month based on your original dose of 1mg, you are implementing a linear taper.  If you are reducing your dose by 6% per month based on each previous month’s dose, you are implementing an exponential taper.  My current ‘I’m still learning about this’ understanding is that implementing a hyperbolic taper requires knowledge of the dose-receptor occupancy curve and/or pharmacokinetic values specific to the benzodiazepine being tapered.  I have not as yet been able to locate this information for clonazepam but am working on it.

The graph you shared above is from Surviving Antidepressants.  It was originally mis-label as showing a hyperbolic taper but has now been correctly re-labeled as showing an exponential taper for one of the antidepressants (hence the starting dose of 100mg).

Scroll to the bottom of the first post on the page to view the re-labeled graph:

Why taper by 10% of my dosage?
https://www.survivingantidepressants.org/topic/1024-why-taper-by-10-of-my-dose

 

 

[[or...]]

Ok, headed over to read the link you gave me, and can't thank you enough   I have seen this very info in your message above somewhere, so I believe I totally forgot, I do remember you saying to me that "probably clear as mud" but I did understand it   so now as I said, I'll go and look at new revised chart, thank you again.  I just feel this is for me, the HT Denise

I don't see a chart showing Hyperbolic Taper, just the Exponential & Linear, but, that's a long thread and it will take more energy than I have for me to read it all at the moment.  I was up wide awake at 2 a.m. but ready, I hope, to catch another couple hours of sleep.

Just came in to thank you again for the info, and when I'm feeling "bright" again, lol, I will see what I can discover on your link, Denise PS this is really over my head, but I will google it and see what I can find as well, I love learning so this will definitely keep me busy after a little more rest "the dose-receptor occupancy curve and/or pharmacokinetic values specific to the benzodiazepine being tapered"

Edited August 25, 2023 by [or...]
added for Libertas reply

[[or...]]

I see, I read your message wrong, I know where the chart is, I am soooo sorry @[Li...]!! Denise

[[Li...]]

No apology needed, @[or...] .  Processing through large amounts of text can be challenging during benzodiazepine withdrawal.  Your interest in learning more about this topic is admirable.

[[or...]]

I did cursor to the bottom, but still only found 2 charts, unless the Hyperbolic Chart is a link, and I missed it?  I hope I am understanding you were trying to send to a chart that was more specific to the HT?  I better try and rest a bit more for now, but I'll check back later, I really thought I had it figured out but see there is much more to learn about it, otherwise, I would already be doing the HT, but according to your definition, I am doing the exponential taper

So what we are searching for is the difference between exponential and hyperbolic taper, am I right ?  ttyl, Denise PS Thank you again @[Li...]

[[Li...]]

Ah ha.  There is no hyperbolic chart.  The point I was making was that the exponential chart had been mis-labeled as hyperbolic in the past.  This has now been corrected.

We already know what the difference is between exponential and hyperbolic tapering.  What we don’t know is the underlying math/calculations for hyperbolic tapering regimens for specific benzodiazepines.

[[or...]]

Ok @libertas I read something in the link you gave me (I just woke up from a sort of nap I guess after not sleeping after 2 a.m.) about how the same with work with benzos.  I'm guessing though there's something deeper in your mention of math/calculations, so I will wait and see what might be discovered in the whole "using" of a Hyperbolic Taper method.

Something came to me as I'd lay there hoping to rest a bit more before I try to start my day.  I remember now, the charts for hyperbolic look just like a slide, so in order to get the Slides gentle curve (instead of the stair steps for exponential) I'm thinking we would have to take our month and start with .001 first day, then .002 next day, etc. until we reach our 10% for that first month?  Each taper from remaining amount of dose, not original tablet.  Is that what would make the gentle curve as the chart below?  And then, the same for each month and of course from remaining dose of previous month?

Maybe silly idea, but I laid there thinking how that "might work" to get the "curve"

here's the chart I drew to show my thoughts on curve. Couldn't find a chart anywhere I searched, that looked like this:

 

 

[[or...]]

Wow, would you believe I can now understand Witt-Doering thanks to your help @[Li...] but again, I will wait to hear from you, but I do under stand the benzo's effect on our Receptors now, at last!!  So a faster taper at first, but then slow it down near the end, seems so simple now, lol!  That forms the slide curve.

I'm on the 1mg and been tapering 6% per month, so it would be good to slow that down near the end of my taper, like 4%, or 3% (2 or even 1%) because a full 6% at the end would "possibly" overwhelm the receptor, so to speak.  It is actually a little like updosing isn't it? I may have that wrong but I'll plug in the video as well here:

 

[[Li...]]

Yes, Dr. Witt-Doerring does an excellent job of explaining the concepts of linear vs hyperbolic tapering in this video. The only minor ‘oops’ comes at the 1:48 minute mark when he describes the dose-receptor occupancy curve as exponential instead of hyperbolic.

I’m not sure what you mean by the receptors being over-whelmed near the end of your taper and this being like an updose.

The ‘big idea’ behind hyperbolic tapering is that very small doses of benzodiazepines have very large effects on the brain (receptor occupancy) compared to higher doses.  To account for the larger effects on the brain at lower drug doses, dose reductions have to be made in smaller and smaller amounts as you get down to lower doses – until you get through the steepest part of the hyperbolic curve at which point you may be able to increase the taper rate because the reductions will have less of an effect on the brain. 

At present, we do not have access to examples of hyperbolic reduction regimens for the different benzodiazepines. However, I was informed today by a knowledgeable and trustworthy source that these will be forthcoming in a soon-to-be published book co-authored by Dr. Mark Horowitz, a leading proponent of hyperbolic tapering, and Professor David Taylor, Director of Pharmacy and Pathology at the Maudsley Hospital, Professor of Psychopharmacology at Kings College London, and lead author of the Maudsley Prescribing Guidelines.

 

 

[[or...]]

19 minutes ago, [[L...] said:

Yes, Dr. Witt-Doerring does an excellent job of explaining the concepts of linear vs hyperbolic tapering in this video. The only minor ‘oops’ comes at the 1:48 minute mark when he describes the dose-receptor occupancy curve as exponential instead of hyperbolic.

I’m not sure what you mean by the receptors being over-whelmed near the end of your taper and this being like an updose.

The ‘big idea’ behind hyperbolic tapering is that very small doses of benzodiazepines have very large effects on the brain (receptor occupancy) compared to higher doses.  To account for the larger effects on the brain at lower drug doses, dose reductions have to be made in smaller and smaller amounts as you get down to lower doses – until you get through the steepest part of the hyperbolic reduction curve at which point you can increase the taper rate because the reductions will have less of an effect on the brain. 

At present, we do not have access to examples of hyperbolic reduction regimens for the different benzodiazepines. However, I was informed today by a knowledgeable and trustworthy source that these will be forthcoming in a soon-to-be published book co-authored by Dr. Mark Horowitz, a leading proponent of hyperbolic tapering, and Professor David Taylor, Director of Pharmacy and Pathology at the Maudsley Hospital, Professor of Psychopharmacology at Kings College London, and lead author of the Maudsley Prescribing Guidelines.

I was trying to paraphrase what he said in the video, and I'll listen again, but I was sure it was the opposite, meaning that when we start the Ht we can cut more, but when we level out when we are into our smallest bits, normally, we need less of the cuts, Like I said instead of 6 percent a month, we need a bit less of a cut.  So I will listen again to make sure of what I'm hearing him say.  And I ask about the updose because if I take less of a cut, I'm adding more to my dose.  But like I've said, my brain is still quite foggy   Thanks for all your time and help @[Li...] I'm in no hurry, so I can wait for more as in the book etc.

 

It's at 3.33 where it starts to say that say I'm down to lowest doses, it can have a huge effect (negative) on the receptor(s).  That's why I thought a person should do less of a taper near the end.  That's confusing me so I'll leave it alone for now thanks again @[Li...] Denise

[[mi...]]

@[Li...] my sister successfully tapered from Ativan 1mg over the course of a year. She said it was hardest between .4mg and .1mg for her and then the rest of the taper was really easy and she walked off with no acute. Is that kind of what you are talking about here? There’s a pinch point that many refer to as hitting a wall (for K it seems to be .15-.2….for me it was .173 and others seem the same). Do you think that’s the point where the cuts have the greatest effect on receptor occupancy in this case. Not those exact numbers but the hitting a wall and needing to make adjustment phase? Some seem to have it easier at the end, some don’t. Wonder why. 

[[Li...]]

Hello @[mi...] 

Yes, your sister’s experience is very much in line with what we’ve been discussing. At higher doses, she was able to make larger reductions but when she got to the steep part of the dose-receptor occupancy curve for Ativan (lorazepam), she had difficulty and I hope slowed down her taper.  Then when she got past the steep part of the curve, she was able to speed up her taper again.  

The same concepts apply to tapering clonazepam but the inflection points will be different because its dose-receptor occupancy curve is different as well as its potency, half-life/blood level buildup/stabilization, etc.  

My current understanding is that once an individual reaches a dose that is well below the lowest therapeutic dose for the specific benzodiazepine being tapered, the dose-receptor curve becomes less steep and the individual may be able to increase their taper rate. 

The key takeaway is that individuals need to monitor their taper rate, withdrawal pattern, and withdrawal symptoms throughout their tapers and adjust their taper rates and intervals accordingly.  Taper planning is a unique-to-each-individual process not a one-size-fits-all/one-time event. 

 

[[or...]]

I'm thinking if I just stick to my 3% each 2 weeks, give or take, I'll be ok.  I got a bit concerned after studying, some of the wrong info on HT, but now I see the HT would really benefit, more so, those that want to hurry up the process.  I'm not into hurrying it up, I've read enough about tapering too fast and I can't afford that at my age.  If I need to cut less I will, I've still got a little jiggle-room with my total of 6% a month   I am always open to learn though so anyone at all is welcome to give me feedback on the way I'm doing it, Denise

[[Li...]]

Hello @[or...] I’m not sure what you mean by hyperbolic tapering being for people who wish to ‘hurry up’ the tapering process.  My understanding is that the intent of hyperbolic tapering is to keep withdrawal symptoms tolerable for all individuals through all phases of the tapering process as well as to inform a possible jump/quit dose for a given benzodiazepine.

[[or...]]

what I meant was, there's a time (in theory) when you can increase your dosage if you want to.  Maybe there might come a time when I feel secure enough to do that but even with my small taper I'm doing now I'm having some sxs I can't explain so attribute them to wd sxs Denise

[[or...]]

Anyone reading my original post, and a couple of replies I made, please understand, I hadn't gotten more up to date info, so much of what I said is the wrong info on the Hyperbolic Taper.  Please read what @[Li...] has posted to be up on what I think is the latest info on it.

For me personally I'll just stick with my taper I've been doing for 5 months as it's working so why should I try to fix it Apologies to anyone I may have misled, Denise 💗

[[Li...]]

No apology needed, @[or...] We’re all in learning mode here. 

I’m delighted the approach you are using is working for you during this phase of your taper.

However, I am puzzled by how you are calculating your reductions.  In previous posts, you’ve indicated you are tapering 3% every two weeks with holds if needed.

According to the taper history you so helpfully have included in your About Me section, your taper rates have been:

0.171 -> 0.152  11.11%
0.152 -> 0.133  12.5%
0.133 -> 0.128  3.76%
0.128 -> 0.127   0.78%
0.127 -> 0.124   2.36%
0.124 -> 0.123   0.81%
0.123 -> 0.120   2.44%
0.120 -> 0.117    2.5%

Can you help us understand the calculations you are using to obtain your doses?   For example, will the math for your next reduction from 0.117 be:

0.117 times 0.97 = 0.113  (this would be a 3% reduction in dose for an exponential taper)

 

[[or...]]

9 minutes ago, [[L...] said:

No apology needed, @[or...] We’re all in learning mode here. 

I’m delighted the approach you are using is working for you during this phase of your taper.

However, I am puzzled by how you are calculating your reductions.  In previous posts, you’ve indicated you are tapering 3% every two weeks with holds if needed.

According to the taper history you so helpfully have included in your About Me section, your taper rates have been:

0.171 -> 0.152  11.11%
0.152 -> 0.133  12.5%
0.133 -> 0.128  3.76%
0.128 -> 0.127   0.78%
0.127 -> 0.124   2.36%
0.124 -> 0.123   0.81%
0.123 -> 0.120   2.44%
0.120 -> 0.117    2.5%

Can you help us understand the calculations you are using to obtain your doses?   For example, will the math for your next reduction from 0.117 be:

0.117 times 0.97 = 0.113  (this would be a 3% reduction in dose for an exponential taper)

 

I am doing my taper by "dose weight" and if there's some imperfection in there, well, I just wouldn't doubt it.  Most times I've tapered in 5 months I've subtracted .003 from previous dose, not original.  So now, am at 32% I have tapered off, and I get that number by taking my original weight (average of 10 Cs weighed on scale). So what's still left is of my dose right now is 68 % of my dose.  That made sense to me, am I wrong?  I could not handle % or barely addition when I got here in March.  Some of those cuts are explained in my about me, and were done before BB.

[[or...]]

I just burnt my breakfast, please let me figure out my own numbers @[Li...] Numbers baffle me, all I really know is my taper is going great. thank you anyway, Denise

[[Li...]]

AOK.  Numbers confuse many of our members so I was trying to lend a helping hand to ensure you were accomplishing your stated goal regarding taper rate.

It sounds like you are making fixed amount reductions in dose based on pill weight and it’s working for you.  Just please be aware that if you continue to make fixed amount reductions in dose, your taper rate will increase over time.

[[or...]]

and I right now, don't get that at all right now, but I've never heard of it before.  What do you mean taper rate increase, do you mean I'll need larger cuts, longer holds, faster tapers??  I also plan to change up my dose depending on wd sxs so doubt it will be a fixed rate.

Edited August 26, 2023 by [or...]
needed to add

[[Li...]]

One way to to reduce your taper rate would be to decrease the amount of your reductions (e.g. from 0.003mg pill weight to 0.002mg pill weight).  But I wouldn’t worry overmuch about this now.  If you reach a point in your taper where you feel you need to make adjustments in your taper (e.g. adjust your rate), members here can help you.