Need help with micro taper

[[Fa...]]

Hi, @[Su...]!  I am responding to your 'tag' here.  I agree with everything @[je...] said.  Without 'reinventing the wheel', here are my opinions/comments:

You switched directly from .5mg tablet diazepam to .3mg/ml liquid diazepam.  You made 2 simultaneous changes to your diazepam dose just 3 weeks ago - change in dosage form (i.e., tablet to liquid) and change in dosage amount (i.e., .5mg to .3mg/ml).  I won't dive into this much further, but it is not surprising you had an increase in symptoms.  The good news is that you stated that your 'symptoms have started to improve greatly'.   This is great news!

You state that your 1ml oral syringe only allows for .2mg/ml reductions?  I'm concerned with this statement.  1ml oral syringes should be marked in increments of 0.01 ml.  As a result, you are able to reduce your 5mg/5ml pharmaceutical oral solution with a 1ml oral syringe by amounts as small as .01mg/ml.

You have a couple options as you and @[je...] discussed.  You could hold at .3mg/ml a bit longer, and when you are mentally prepared you could discontinue your diazepam.  If you feel more comfortable tapering lower, we need to ensure you are properly using your oral syringe to dose, and reduce, your diazepam.

In regards to adding an AD, you stated that you'd 'never felt depression like what I experienced with this last drop', but were also 'improving greatly'.  If this is the case, my opinion would be to hold off on adding an AD to the mix for the time being.

I hope something in this was helpful.  You've obviously done a great job with your taper, and are at the finish line - congratulations!

[[Su...]]

@[Fa...] thank you so much for your reply!  You are correct that I did switch from tablet to liquid and decrease my dose all at once. But yes I’ve been very grateful and blessed to notice things have improved in the following weeks. However I am noticing I seem to have one good day then I have trouble sleeping that night and the next day I’ll have more burning in my chest and arms, GI issues, and restlessness..idk why it seems to come and go from day to day. 
 

I miss spoke about my 1ml syringe. It reads 0.1 ml to 1ml and between each number there are four little lines that I thought were equal to .02 I guess I’m not reading the little lines in between .1 and .2 correctly.. either way I am at 0.3. I just ordered new .5 syringes because I was thinking it would help me decrease in even smaller dosages? I think I would like to try to go even lower because I don’t think there would be any harm in going off incredibly slow right? 
 

In regards to the depression yes it has kind of changed as well. When I was experiencing symptoms right after the cut it was a very deep and dark, but it has held on and seems to ramp up when my other symptoms ramp up. It almost feels like I’m cycling through them day to day pretty rapidly. Is this common? I also don’t want it to go back to being extremely dark as I have to be there for my family. 
 

Have you seen this increase in symptoms at the end before? Does it usually level out from here even though I have more to taper? Thank you for all of your help. I’m noticing a big need for reassurance in all of this, that I will go back to normal again.. 

[[Su...]]

@[Fa...] Also- after I started experiencing all of these symptoms I cut things out of my diet pretty dramatically. I have not been eating gluten, I also don’t eat dairy or very limited amounts, and I cut out sugar with the exception of natural sugar like maple syrup and honey, and I don’t drink coffee or soda or anything with caffeine. Any opinion about these things as well? 

[[Li...]]

Hello @[Su...].  I agree with @[Fa...] that the uptick in symptoms you experienced when decreasing from 0.5 to 0.3mg, may be due in part to the dosage form change.  However, based on what I have been learning about the neurobiology of withdrawal, another factor to consider is that the drug may still be having an effect on your brain and the reduction you made was ‘too much’ for it to handle.  

Per Horowitz (see video below) when the change in effect on a given individual’s brain is less than the size that has been previously tolerated, the individual can go to zero.  Your brain did not tolerate a 0.2mg reduction so smaller, more gradual steps are likely indicated for the final phase of your taper.

There are many ways you could approach this.  For example, you could try reducing in steps of 0.01mg (i.e., 0.30, 0.29, 0.28, 0.27, 0.26, 0.25) followed by a hold at 0.25mg to see how you tolerate that series.  If symptoms are tolerable, you could quit.  If not, you could try another series of 0.01mg reductions (i.e. 0.24, 0.23, 0.22, 0.21, 0.20).  If you discover you need to make smaller steps, you could dilute your liquid. 

 

 

 

[[Su...]]

@[Li...] thank you! How would I dilute my liquid? I know putting the cart before the horse a little but I’m curious. Do you also think that at this low dose I am not getting therapeutic effect? If so why would the medication still be causing such an uptick in symptoms? If most people jump off from here do they have a huge uptick in symptoms that then levels out? 

[[Su...]]

@[Li...]@[Fa...] can either of you tell me what this feeling in my chest is, if almost feels like when your heart palpitates but it’s not, it’s like a feeling of discomfort right near my sternum- not pain but like a flutter or something but it’s not my heart palpitating..

[[Li...]]

You’re welcome @[Su...].  Therapeutic effect and effect on the brain (i.e. receptor occupancy) are not the same thing.  Our brains are unique to us so we all respond differently to reductions in dose.  For example, if you are on the steep part of your unique receptor occupancy-dose curve, very small changes in dose can have a very large effect on receptor occupancy.

Diluting pharmaceutical liquids is easy.  You simply add water (preferably purified or distilled) to achieve the desired target concentration.  For example, to achieve a liquid with a concentration of 0.1mg/mL, you could add 1mL of your 1mg/mL pharmaceutical liquid to 9mLs of water.

[[Su...]]

@[Li...]okay thank you! I’m sorry my brain is not working like it should right now.. I tried to ask my husband about diluting the liquid and told him what you said, he gets it but I’m having trouble understanding that right now which then causes me to feel anxious because why am I having such a hard time understanding.😞

I kind of get it, but wouldn’t I be using more of the liquid then? And would I put 3ml of the solution in 7 mls of water, my brain isn’t getting how that would not still be 3mg of medication even though it’s watered down.. 🤦🏻‍♀️ 

 

and if I were to step down in extremely small increments like that how much longer would I have to continue with the taper? 

Edited October 13, 2023 by [Su...]

[[Fa...]]

@[Su...] I, nor anyone else, are going to be able to wholly, and satisfactorily, answer some of your questions unfortunately.  I'm sorry you are experiencing some uncomfortable symptoms.  Not to diminish your suffering, but most of us discontinuing a benzodiazepine experience some unpleasant symptoms.  The key is discontinuing in a fashion that keeps these symptoms 'manageable'. 

With that said, @[Li...] just addressed the issue perfectly regarding how to achieve this in your situation.  I was looking for clarification regarding your liquid dosing via your oral syringe before I 'dove into' this.  She is the one whom helped 'lead this horse to water'.  My gut says you will not need to dilute your pharma liquid, though @[Li...] has outlined this for you if the time, and need, arise.

@[je...] mentioned stress and anxiety increasing symptoms.  This is something to strongly keep in mind as well.  I would recommend being very kind to yourself down this home stretch.

Lastly, you also mentioned drastic diet changes as of recent.  I'm just pointing this out, as all of this can play a part in symptoms and their severity.  Your body craves consistency right now.  I would suggest holding your dose steady, holding your diet relatively steady, and ensure you feel 'stable' before proceeding.  @[Li...] outlined a perfect trial 'strategy' above in my opinion to continue your taper once ready.

[[Su...]]

@[Fa...] you are correct, I know that no one can really tell me or answer my questions completely, but somehow I feel like having some sort of idea brings a little comfort. I think I’m confused as to why I was doing okay with the taper all the way to this point and now at such a small amount I’m really struggling.. 😔

I was feeling so good after a month or so of holding at 1 mg it was truly a beautiful blessing and I keep holding onto that as a goal for where I want to be mentally, I think I get discouraged thinking this could drag on and on or that I’m doing something that’s causing all of this or maybe there is a way I can ‘fix’ or alleviate it. 
 

You are absolutely right, everyone here is experiencing symptoms to one degree or another and I am very blessed that I am where I am. 
 

I have tried to  go easy with all of this and I am very blessed to have the support of my family however seeing all that my husband and mother in law have been doing to help makes me feel guilty because I feel like I’m not taking care of them. 
 

Thank you all for your help, it means a lot. 

[[Fa...]]

You are doing a great job, @[Su...].  Stay focused on the positives - you handled the taper all the way to this point doing okay, and you will end up okay!  You have just hit a little rough patch that will pass.

I know it's frustrating when we go down the rabbit hole as to the whys and wherefores.  In your case, it is probable that one or two of your most recent reductions were just too large for your body/brain, and the possibility of switching to liquid simultaneously did not help.  It is ok.  Your brain will adjust and 'stabilize'.  I have made way larger mistakes in my taper as I was so uninformed.  You will stabilize and complete your quest to discontinue diazepam in the very near future!

[[Su...]]

@[Fa...] thank you so much for all of your encouragement. Are you off completely now? How are you doing? 

[[Fa...]]

You're very welcome, @[Su...].  I am unfortunately still tapering and have a ways to go; however, my symptoms are 'manageable'.  I'm doing ok and try to focus on my blessings like you.  Thank you for asking.

[[Su...]]

@[Fa...] I am glad to hear your symptoms are manageable! Could I ask what that means for you? I know this looks different for everyone but for me having two young children I feel terrible when I have to keep going and laying down to try to feel better or when I have a hard day and most of my time is spent laying down. 

[[Fa...]]

@[Su...] I completely understand.  I have a wife, and two young children as well - an almost 7 year old boy and an almost 1 year old baby girl. It is hard, but these are my people whom I love dearly and draw strength from.

Insomnia is my most troubling symptom.  Some people this does not seem to effect as much, but I used to be a relatively good sleeper and it has been difficult for me to adjust.  All my other symptoms seem to be related to sleep, or lack thereof.

’Manageable’ to me is that I am able to work, be a husband/father, and sleep 4-6 hours (though many of which are light and disrupted).  I never feel good unfortunately, but I usually feel ‘ok’.

Practicing what I just ‘preached’ to you - managing my stress and anxiety.  Being kind to myself.  Giving myself some grace.  I don’t do these things well, but I’m getting better.  I am very hard on myself because the best version of myself is currently nowhere near my best.  But I have hope, and know that I will recover.  I can do most everything I could do prior, just not as well as I would like.  ‘Faith’ it ‘till you make it. 

[[Su...]]

@[Fa...] wow, it’s humbling and strangely comforting to know there are others with young children going through this too- even though I wish you weren’t. Have you experienced any anhedonia(sp) related to your family? This has been extremely troubling to me, my children and my husband just a few months ago brought me such joy, and now I am having a hard time feeling.. I’ve never experienced that before so that leads me to believe it is definitely benzo related. 
 

I hear you with the insomnia troubles, I’m sorry you’re experiencing it. I seem to have more intense symptoms the day after I don’t sleep. 
 

I am grateful that in the midst of your struggles you are on here reaching out to help others. Thank you. 

[[Su...]]

@[Fa...] can you explain what kindling is? It’s scaring me.. 

[[Fa...]]

@[Su...] Anhedonia (the inability to feel pleasure) is a common symptom of benzo withdrawal, associated depression etc..  If you haven’t experienced that before, it is most certainly benzo withdrawal.  I’m sorry you are experiencing it. 

Honestly, I don’t go down too many rabbit holes with my symptoms.  I know they are all benzo related, and the list could potentially get quite long.  All I know is I feel a lot, and unfortunately pleasure is not a regular feeling these days.  Who wants to be dealing with this!? 

With that said, I have no doubt the love I have for my family, and they bring me much joy.  I just don’t want to be dealing with this mess and want to feel good again.  Oh, and did I mention a good nights sleep would go a long way 😉.  Stay strong.  You are almost there and on your way to healing! 

[[Fa...]]

8 minutes ago, [[S...] said:

can you explain what kindling is? It’s scaring me.. 

Repeatedly starting and stopping benzodiazepines.  I would highly encourage you to try your best to not unnecessarily worry and stress at this time.  Again, focus on the positives and take care of yourself.  You would not have felt okay a month ago at 1mg if kindling was a relevant issue for you.

[[Su...]]

@[Fa...] you seem so mentally strong going through this, a quality I hope to gain. 
 

I agree God engrained the love we have for our family deep within our DNA, we love because he first loved us. 
 

thank you for the reply about kindling, it seems like there is always another fear to chase in this or that will try to chase you.  Is it only related to withdrawing from benzo’s? Do other medications cause that too? Like SSRI’s? 
 

[[Fa...]]

@[Su...] I'm not well versed regarding the topic of kindling; however, sedative-hypnotic drugs such as alcohol and benzodiazepines are most commonly associated with this neurological condition.  I wouldn't give this particular topic much thought.

Another member reminded me about Jennifer Swantkowski’s YouTube channel - particularly her post regarding the importance of developing, and practicing, a non-engagement response to symptoms.  I have left the link below in case you were interested in viewing.  In essence - obsessing, ruminating, and catastrophizing about the symptoms and situation is common in benzo withdrawal, and have the potential to literally make individuals sick on their own.

 

[[Su...]]

@[Fa...] thank you for everything! 

[[Fa...]]

Hi, @[Su...]!  I just saw where @[pi...] replied to, and ‘bumped’, your new taper thread.  Have you considered proceeding forward with the suggestion @[Li...] gave you in this thread?

On 13/10/2023 at 13:18, [[L...] said:

There are many ways you could approach this.  For example, you could try reducing in steps of 0.01mg (i.e., 0.30, 0.29, 0.28, 0.27, 0.26, 0.25) followed by a hold at 0.25mg to see how you tolerate that series.  If symptoms are tolerable, you could quit.  If not, you could try another series of 0.01mg reductions (i.e. 0.24, 0.23, 0.22, 0.21, 0.20).

[[Su...]]

Hi @[Fa...] yes, I am considering this- however someone else mentioned doing I believe it was 15% per month and I was wondering what the difference would be? They were suggesting 15% per month and that it would take 6 maybe 7 more months. I also tried to math out just going down in increments off .01 per week and figured it would also take about 6 months. I plan to go based on sx so I know it could take longer but having a general game plan would be nice. 
 

Im trying to get ready mentally for what I may have to endure..if I were to continue to try to taper right now it would be a lot but people are telling me they never felt good during their taper. Why do you think that is? Meaning why don’t we level out until after we’re off the medication? Maybe that’s a silly question?

[[Fa...]]

@[Su...] A 15% monthly reduction from .30mg would be to reduce by .04mg/mL over the month to a new total daily dose of .26mg/mL per day.  I, however, would not worry yourself with exponential reductions, and the associated ‘math’, at this low dose of diazepam - nor would I recommend dragging this last bit of your taper out unnecessarily.

I would suggest proceeding with Libertas example series of reductions reducing by .01mg/mL per day for 5 days and say hold for 2 weeks and evaluate from there - obviously once you feel ready.

Diazepam at your dose is below any therapeutic value.  My opinion would be to not be unduly slow getting off this remaining dose.  This is just my opinion however, and you must feel comfortable with how you are proceeding.  I anticipate ‘more of the same’ as your worst case.  You are so close to the end, and your brain will heal itself of any changes made by the medication.