Steepest part of receptor occupancy curve for Diazepam

[[re...]]

I know I am shooting in the dark here so please forgive me. No one really knows one hundred percent. And theories are theories, but I do think Mr. Horowitz is onto something with his hyperbolic curve study and his own experience with regards to receptor occupancy. Does anyone know if it is from 3mg to 2mg or 2mg to 1mg or 1 mg to 0. Or is it just steep all the down from 3 to 0.. 

Edited March 18 by [re...]

[[Ma...]]

It’s gonna be different for everyone.  I’ve wondered the answer to this question because I do think there are people that can kind of speed up when they get past a certain low level.  I hope to be one of these people but also recognize there are people who struggle all the way down.  I think you also have to keep in mind, we all have different brain sizes/weights and therefore different numbers of GABA receptors. We also all metabolize the drugs differently so it’s probably really hard to say on an individual basis.  

[[re...]]

Matt:

Yes very individual especially with brains and that is why I never understood these generic protocols with Docs regarding head meds or any medicine really. I understand there needs to be a point to start from, but then improvisation is so important due to a patient's unique makeup. 

I am still so so curious about this new info come to light via Mr. Horowitz. j

[[Ma...]]

I watched the video where he talked about it and I think it’s reasonable.  Anecdotally, I’ve talked to several people who made it past some point on their taper and then had it either a little easier or not as bad the rest of the way down.  In addition to the chemistry of it there’s obviously a lot of psychiatric differences between all of us too so that just adds a little more uncertainty as to how it will play out.  For this reason, if I see a post with a horror story I try to avoid it like the plague.  

[[Li...]]

4 hours ago, [[r...] said:

I know I am shooting in the dark here so please forgive me. No one really knows one hundred percent. And theories are theories, but I do think Mr. Horowitz is onto something with his hyperbolic curve study and his own experience with regards to receptor occupancy. Does anyone know if it is from 3mg to 2mg or 2mg to 1mg or 1 mg to 0. Or is it just steep all the down from 3 to 0.. 

@[re...] Tip of the hat for recognizing that hyperbolic tapering is theoretical at this point.  If memory serves, there have been one or two studies of hyperbolic tapering of antipsychotics and there is one study of hyperbolic tapering of antidepressants vs usual care currently underway.

What benzodiazepine are you referencing?  Diazepam?  If so, the example for a faster hyperbolic tapering regimen for diazepam in The Maudsley Deprescribing Guidelines has up to 5 percentage points of GABA-A receptor occupancy between each step, with reductions every 1-4 weeks. The moderate regimen has up to 2.5 percentage points of GABA-A receptor occupancy between each step and the slower regimen has up to 1.3 percentage points of GABA-A receptor occupancy between each step.  

This means that the actual diazepam dose taken varies by tapering regimen.  For example, for the faster regimen, starting at a total daily dose of 3mg, the steps are 2mg, 1mg, 0mg.  For the slower regimen, starting at a total daily dose of 2mg diazepam, the steps are 1.8mg, 1.6mg, 1.4mg, 1.2mg, 1mg, 0.8mg, 0.6mg, 0.4mg, 0.2mg, 0mg. 

As Horowitz and Taylor (the co-authors of the guidelines) are careful to point out:

“Please note that none of these regimens should be seen as prescriptive … They are given as example regimens and are not ‘set and forget’ but should be modified in order to ensure that withdrawal symptoms are tolerable throughout a taper.”

[[re...]]

Matt: Yes sir I think he is really onto something here and he does talk even about opiate/heroin addicts back in the day doing these hyperbolic tapers and it being very successful. It would be nice to think that as long as we are taking it easy as we get lower and haven't shocked ourselves too much. Then we could maybe do a smoother taper from say 1mg Diaz all the way down without a ton of trouble. I can certainly dream. I have been functional throughout this taper and lots of windows, but the waves hit HARD let me tell ya. The whole gambit of symptoms. 

Libertas:

Thank you for that detailed post. I appreciate your attention to my inquiry. Yes I am tapering Diazepam and currently at 1.3 mg from 5mg I started tapering last May. 

I do think Horowitz is onto something major here and I would just LOVE to see more research done into this with actual human volunteers and putting these people on eeg/spect machines sleep studies etc as they taper in a hyperbolic way to see brainwaves and all that in a more scientific way. I mean these drugs have certainly damaged enough people from treating them like addiction medicine and insane fast tapers weather inpatient or outpatient. I would really like to see the scientific/neurology community get in on this. The money and wasted doctor specialist visits alone would be worth more study in this area for sure. 

Thank you again for your detailed info.