Help with tapering off Xanax

[[Co...]]

14 hours ago, [[J...] said:

@[ou...] @[Li...] @[Br...] @[An...]

Thank you all for the warm welcome and the guidance!  I have questions 🙂

1. Is it better to move from 1x a day dose to two or three?

If you suffer from significant interdose withdrawal effects, then redistributing your dose over the day might be a good option for you. But if you are not suffering significant interdose withdrawal effects, it might be counterproductive. There is some advantage to being less chronically dosed over the day, as chronic dosing is associated with dependency. For example, taking a short-active z-drug just once per day is far less likely to lead to dependency* compared with taking Valium once per day (or even Xanax once per day). But if you are suffering significant interdose withdrawal symptoms then this is suggestive of significant dependency anyway. And in any case, these interdose withdrawal effects probably need addressing anyway.

My general perspective on these things is to do not fix what ain't broken.

* When taking z-drugs once per day (at least at more moderate doses), developing (a deep) dependency is not very likely. If we were to move to (for example) splitting the single dose into three one-third doses over the day, we would increase the chances of developing significant dependency. On an associated matter, Prof. Ashton would advise that quitting from a single daily dose of a short-acting z-drug was feasible when taken just once per day, as it was unlikely that patient had developed dependency.

14 hours ago, [[J...] said:

2. When I move to my new schedule of 2-3x a day dosing will I notice a physical change?  Is that why you’re saying to do that first without making a cut to the dose amount?

Changes are best carried out gradually. In your shoes, I think I would try swapping out just a third of my dose for about 8 hours before my two-thirds dose. The rationale being:

1. It is generally better to make gradual changes
2. The two-thirds dose will last longer (over the 16-hour period to the next one-third dose)

And I suggest that these timings are adjusted according to how you feel/react.

After a week or two, if you feel the need, you might then move another third of your dose so that you are taking a third of your daily dose about every 8 hours.

But these things are highly variable to the individual. For example, if you are used to taking your total daily dose at night before you go to sleep, you might find that redistributing your dose over the day might cause you too many problems with sleep. Other members of BB can (or should) supply you only with ideas for various approaches. But what might worked for them or other members might not work for you. The decision is for you to take, as you are the best judge of what's happing with you, how you feel, and how you react. And it is always advisable to keep your doctor informed too. (I know this - for various reasons - is not always practicable. But it remains my general advice.)

14 hours ago, [[J...] said:

3. How in the heck do I cut these things to get to the tapered doses?  They crumble into a million pieces lol!

Over the years, I have been more convinced that crushing pills and using scales is the more reliable way to go when devising a scheme at home. Another better method (if you prefer using a liquid) is to talk with your pharmacist about using an across-the-counter suspension agent.

14 hours ago, [[J...] said:

4. I’m currently getting off caffeine this week and about to be done with the horrid headaches. I’m thinking it best to make any changes to my Xanax start of next week when I get back to my regular schedule post holiday and post caffeine withdrawal. Agree?

Yeah. If you are a regular drinker of coffee (or tea for that matter), it is better to reduce consumption gradually. To be clear: are you are suffering from headaches as you gradually reduce your intake of caffeine? Are you doing this too quickly?

14 hours ago, [[J...] said:

5. Are there things I can do to help support my body through this process?  I’ve read eating well, staying hydrated…things of that nature are helpful.

Anything we can do reduce other stress points can only help. But there is no magic bullet of course. Do what you can live healthily is generally good advice anyway.

14 hours ago, [[J...] said:

I plan to continue my weekly therapy sessions - plenty of work left to do.  She is very supportive and responds quickly when I’m struggling in general 🙂

That's very good. Good luck.

[[Ja...]]

@[Co...]

Thank you for your response!  Much to consider and I appreciate having options 🙂

Earlier this year when I was taking steroids (it’s like an anxiety party when I take them) I did start to take my Xanax 3x a day.  At that same time I spoke with my PCP’s PA and told him I wanted to quit Xanax altogether to which he suggested I go cold turkey and take hydroxyzine.  I did end up going to the ER when I followed his instructions and I can’t say whether or not it was the cold turkey cut or the hydroxyzine alone that made me have chest pains (maybe a combo?).  I do know that when I take hydroxyzine without making cuts that I still get mild chest pain so I discontinued it.  While at the ER they did not find any heart conditions and I did follow up with a cardiologist and same, no heart issues (just overweight which I’m addressing).  At some point in April I decided to only take Xanax in the evening so I could at least sleep.  I did have moderate and sometimes heavy rebound panic throughout the day but I decided to push through it not really knowing I had other options.  At this time I started my therapy journey of processing lifetime PTSD, GAD, and depression.  I was throwing everything at my physical discomfort…CBT exercises, reading self-help books, breathing, meditation, movement, and weekly EMDR sessions.  I’m assuming my ignorance to the process of tapering and pushing through is not advisable and so I’m not advocating for my process, just providing my background 🙂  Fast forward to the last two months where things that should have triggered me and thrown me into chaos for days…have not!  I even went to a wedding with 180 people and although I considered taking Xanax, I didn’t and although I was extremely drained, I made it through.  This takes us to the last two weeks where I decided it’s time to come off Xanax - I think my support system and my tools are as strong as they may ever be!  I have Fibromyalgia and my doctor has said that long term Xanax use is linked to muscle/joint/deep tissue pain and if that’s the case for me, this drug is hurting me physically and I would like to live life without it.  Whatever that looks like, or feels like mentally…I want to have a choice or feel like it anyway.  So anyway, I cut my dose in half at bedtime for a few days and my mind was racing, I was agitated, felt restless, tightness in my chest, and general worry.  BUT if staying on a once per day schedule but not such extreme cuts will work or prevent further reliance upon this drug, I would like to try!  
 

Would I cut 5-10% from my evening dose to see how that feels?  

[[Ja...]]

@[Co...]

In terms of the caffeine withdrawal, yes, I did this too quickly - I cut it out cold turkey.  This has unfortunately been a normal pattern for me where I stop/start because I do have eating issues that I’m also addressing.  Sodas are the caffeine problem for me…soooo all of this to say I do know where I’m at with my caffeine withdrawal and I’m past the headaches and general fog so I should be at a level place come this weekend.  The junk food binges are lasting less and less each time they happen so progress is being made.  My father was a narcissistic alcoholic and had me on a perpetual diet as a child (some of his methods were less than kind and highly traumatizing).  I stopped talking to him last year which is how I embarked on this healing journey.  He passed away this June due to his alcoholism and other related health problems.  A weight has been lifted and here I am 💙

[[An...]]

OP said>>>

Quote

 I did end up going to the ER when I followed his instructions and I can’t say whether or not it was the cold turkey cut or the hydroxyzine alone that made me have chest pains (maybe a combo?). 

I would put my money on the Benzo CT here.

[[Ja...]]

Just now, [[A...] said:

OP said>>>

I would put my money on the Benzo CT here.

Yeah, if I’m being honest, I would agree.  I still don’t like the way hydroxyzine makes me feel but it probably only made matters worse.  It makes my chest tight and makes me feel drunk - that drunk feeling makes me feel less in control and then panic sets in. 

[[An...]]

OP said>>>>

 

Quote

 

 BUT if staying on a once per day schedule but not such extreme cuts will work or prevent further reliance upon this drug, I would like to try!  
 

Would I cut 5-10% from my evening dose to see how that feels?  

 

Yes, if you are used to dosing only once per day, I would try sticking with that doing the 5-10% cuts. You can always modify if you need to.

 

[[Br...]]

@[Ja...] Keep us posted please, so we can help support you. 

[[Ja...]]

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

@[Ja...] Keep us posted please, so we can help support you. 

Absolutely!  I think I’m going to try the once daily approach and do the 5-10% reduction, but starting at the 5% first and see how I feel.  I’ll give myself the two weeks to lean into it and not rush - my husband is on standby as my accountability partner as I am known to rush things 🙂 He’s also been great at reminding me that just because I can’t snap my fingers and be done with this drug that I’m not a failure. 

[[An...]]

2 hours ago, [[J...] said:

Absolutely!  I think I’m going to try the once daily approach and do the 5-10% reduction, but starting at the 5% first and see how I feel.  I’ll give myself the two weeks to lean into it and not rush - my husband is on standby as my accountability partner as I am known to rush things 🙂 He’s also been great at reminding me that just because I can’t snap my fingers and be done with this drug that I’m not a failure. 

Good to hear you have the support of your spouse. All these things coupled with a sensible taper increase your chances of success.

[[Ja...]]

6 hours ago, [[A...] said:

Good to hear you have the support of your spouse. All these things coupled with a sensible taper increase your chances of success.

Thank you 🫶🏻