Why I prefer a microtaper over a 'cut and hold' taper

[[cu...]]

I can really recommend microtapering. I hope it's okay I attach a picture from the book Maudsley Deprescribing Guidelines.

Example of 'cut and hold' tapering vs microtapering:

-Let's say you take 5mg and then cut and hold to 4mg for 4 days. At the end you will be at 4mg and the total amount of benzo decrease is 1mgx4=4mg (this is relevant for long-acting benzo's).

-If you go from 5m to 4mg in 4 days by microtapering, you would decrease the dose by 0,25mg each day. The total amount of benzo decrease would be 0,25+0,50+0,75+1=2,5mg. So you would be at the same dose after 4 days, yet the cumulative decrease is less, making it more gentle.

Also, regardless of whether you're taking a long-acting benzo or a short-acting benzo, each step is smaller, decreasing the chances of withdrawal and making symptoms come up more gradually and more subtly. If it still becomes (too) intense, you can make the steps smaller or pause at the same dose. The risk of having to up the dose to stabilize again is smaller than when you make bigger cuts at once. It's the difference between trying to take 4 steps at once walking down a staircase, not sure if you can, risking a fall. Vs taking it step by step, pretty sure that you can handle each step. You're more likely to be able to hold the progress you have made. And personally I just find it takes away some anxiety about the process. Which is esp. helpful since anxiety can be a withdrawal symptom as well.

Microtapering also makes a hyperbolic decrease more feasible and thus a more even intensity of withdrawal symptoms.

Also, when I was doing a regular 'cut and hold' taper using a pill cutter, it was highly inaccurate: the halves of the pill would often not be the same size, often there would be crumbles and cutting the pill in quarters made all this worse.

For microtapering, I ground, use filler and weigh the final powder. More about how I do that here: 

 

 

Edited April 14 by [cu...]

[[Ma...]]

Both methods have advantages and disadvantages.  One of the problems with microtapering is that if you start having symptoms, it’s hard to know what dose to try and stabilize on because you are cutting every day and the half life of these drugs is long, so it isn’t necessarily the last dose where you felt stable. This is exactly what happened to me.  I was going along at a slow/moderate pace with a micro taper and suddenly symptoms picked up quickly.  It was not smooth at all and I ended up having to go up a good bit to stabilize.  It took me a while to find that dose where I felt stable again and I had to hold there for a while.
 

For many microtaper works great, just a word of caution - I would suggest going with a slow micro taper.  You can really play it safe by still taking some holds with a microtaper to make sure you are, indeed, stable.  I find doing very small cut and holds with a scale easier because I can always get used to a new dose for a week or two and feel confident when I cut again.  If I’m going to start having worse symptoms, I pretty much know it’s going to happen around day 4-5.  With a microtaper I had no idea.   I’m now below where I was doing microtaper and doing much better.  
 

Weighing is an issue, even with a decent scale.  I cut my pills up for a week and try to get them within .001-.002 mg of each other.  I then look at the weight of those 7 pills compared to the 7 pills I took the previous week.    

Edited April 14 by [Ma...]

[[Ma...]]

On 14/04/2024 at 21:48, [[M...] said:

One of the problems with microtapering is that if you start having symptoms, it’s hard to know what dose to try and stabilize on because you are cutting every day and the half life of these drugs is long, so it isn’t necessarily the last dose where you felt stable.

Hi @[Ma...], can I ask you a question? What are your thoughts on Lorazepam, related to what you describe? I’m doing ‘cut and hold’ right now but want to start microtapering. Although Lora has a medium halflife, I tend to get real symptoms around day 6, so pretty late I guess. So will I be on time with noticing symptoms (other than usual ups and downs)? Any idea on how to avoid that scenario?

(I’ve made a topic of my own, you’re also welcome to answer over there. Don’t want to ‘h*jack’ this topic.)

[[th...]]

Im spoke with Angie Peacock and I just did a water taper today while in full tolerance withdrawal and it’s terrible!!! 

[[Ch...]]

On 14/04/2024 at 14:00, [[c...] said:

The total amount of benzo decrease would be 0,25+0,50+0,75+1=2,5mg

You have some really interesting things to say. Thanks!

But can I ask a favor? When you write intended decimals using a comma (e.g. 0,25 instead of 0.25), it can get terribly confusing...so, could you please write them the standard way?

This: 0,25+0,50+0,75+1=2,5mg

would become this: 0.25+0.50+0.75+1 = 2.5mg

[[Li...]]

@[Ch...]

Members of BenzoBuddies live in many different countries.  Different countries use different decimal separators.

For example, the United States and the UK use the decimal point.

However, many European and South American countries use the decimal comma. 

To learn more:

Decimal separator - Wikipedia

 

 

 

[[Ch...]]

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

@[Ch...]

Members of BenzoBuddies live in many different countries.  Different countries use different decimal separators.

For example, the United States and the UK use the decimal point.

However, many European and South American countries use the decimal comma. 

To learn more:

Decimal separator - Wikipedia

That's very interesting. Thanks for the information. It remains confusing, but now I know.

[[Rh...]]

I was able to successfully taper off my benzo 4 years ago using the micro taper method as cut and hold was much too hard for me.  But when it came time to taper my AD I tried to also do a microtaper and found that it made things worse.  I switched to a cut and hold and successfully tapered off my AD 9 months ago.

I will note that I am in severe acute WD from my AD taper even though I did follow the Ashton Protocol (even went slower than her recommendations) so who knows if I did the right thing.  All I do know is that I think if if rapid tapered or cold turkeyed I’d be in a much worse place (like the psych ward), so I do think 100% a slow taper (if your able) is the way to go.