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Advice needed for Lora taper


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[Ma...]

Hi all,

I have a long story behind of me and there's a lot more to come I guess. So, gonna be a longread with questions for advice.
Thank you for reading in advance!

2023
Beginning of 2023 started to taper my last few mg's of Paroxetine.
Wanted to go from 3mg to 1 mg in 2023 en 1mg to 0mg in 2024. I thought that was pretty slow already, but boy was I wrong.
Crashed on 2,2mg end of March, did an immediate updose to 2,5mg without relief and suffered severe withdrawal incl. crisis/hospital two times in april. Nobody suggested a full reinstatement back to 3mg...
In March/April used Oxazepam (different amounts, different times, no schedule).
In April I was switched to Lorazepam. It saved my life at that point (I serious wanted to end my life), but also gave me another problem.
Few months forward. Tapering Lorazepam went to fast (doctors have no clue...), crash again. And still struggling with Paroxetine withdrawal.
In August met a kind and capable psychiatrist and together made the decision to do a re-instatement for Paroxetine. In 5 months time I got back from 2,5mg back to 3,0mg (my old dose for two years, after I tapered down from 10mg to 3mg in 2021). Paroxetine reinstatement solved around 80% of the withdrawal. Luckily.
Not changing that dose anymore.

Last year I did a lot of research to know what was happening, because healthcare providers and doctors had noooo clue. So, there was Ashton, Horowitz, DeWitt-Doering, Benzo Info Coalition. That prepared me a bit for 'adventure' nr 2: tapering Lorazepam.


2024
After 1 year of benzo-use (last 10-11 months just Lorazepam) I started my taper February 1st. Was pretty confident because of the small steps I had planned.
Since december 2023 I was on 3x 0,566mg (each dose: one 0,5mg tablet and two drops liquid). 
Started to taper with the liquid (2 drops mixed with water to make small steps). The idea was to make 0,022 steps per 2 weeks, but that turned out different.
--> First step: 0,566 --> 0,544 turned out as a real 'cut and suffer' one. Got symptoms after 4 days, still present at day 14, postponed next cut, got a bit better at day 20, got hit with by huge depression and suic. ideation at day 21-28, postponed the next cut untill day 31.
--> Smaller second step: 0,544 --> 0,533 turned out better. Got symptoms after 6/7 days, got better at day 19. Next cut made on day 21. Week 1 was 'good', week 2 less, week 3 was worst.
--> Third step: 0,533 --> 0,522 = current step. Got symptoms after 6/7 days, did get better for 2 days around day 14-15, then got hit again with sever depression and suic. ideation (next to the other symptoms). Week 1 was 'good', week 2 less, week 3 was worst. Today was supposed to be step 4, but I'm still a mess. 
So I'm reconsidering my strategy. And I want your advice if possible.

At this pace (around minus 0,01mg every 3 weeks) it will take me 3-4 years to get to zero. I can't get my mind around this... I really have no clue how to keep myself going, feeling the way I did last few months tapering (and also with horrible 2023 'in my backpack'). 
So, I read and saw video's on microtapering. I'm in a Dutch online supportgroup for emotional support (native), but they are pretty strict on 'cut and hold'-taper' every two weeks to prevent tolerance' and have little experience with advising a microtaper.


SHORT TERM
My idea for tapering the next 0,022mg (until I reach 0,5mg tablet):
- My dilution is: 0,4ml = 0,022mg Lorazepam. That is 40 stripes on the syringe.
- I can choose to make a 1 stripe cut (0,00055mg) every day (40 days total) or 2 stripes cut (0,0011mg) every day (20 days total).
Q A|   What would you recommend, knowing previous symptoms related to time/pace? The second option would be a testcase for the long term as written below.

LONG TERM
Once I reach 3x 0,5mg, I'd like to do a microtaper (short term written above would be a test to see if that's an option).
My idea would be to mix 0,5mg with 200ml water and take out 0,5ml (=0,00125mg) every day. That would get me down 0,02mg every 30 days.
I would do that untill I reach 3x 0,25/0,20mg (that would be max. minus 9-10% per 30 days). And then continue with a hyperbolic rate; smaller steps closer to zero.

I guess there is a ton of experience on this forum, so I have a few questions on microtapering:
Q B|   What is prefered: doing a watertaper with solving a tablet (suspension) or solving a liquid (dilution)? The only Lora-liquid available in Holland is 1mg/ml (compounded pharmacy).
Q C|   Cut and hold is pretty clear: make a cut, wait 'till symptoms get better, make a next cut. But how does this work with microtaper? Do the symptoms keep piling up without any form of stabilisation? And if you want to stabilise, is there a risk of being 'to late' because of the cumulations of symptoms?
Q D|   What is the risk of reaching tolerance (-withdrawal) when doing a microtaper?
Q E|   What is better for avoiding protracted withdrawal after reaching zero: cut and hold or microtaper?
Q F|   What reasons do people have to not do a microtaper or go back to 'cut and hold'? 

 

DETAILS (also in profile, incl everything before 2023)
2023: March 1-24: around 60mg oxa total. After March 25: oxa daily around 5-30mg, April 12: switched to 1mg Lora daily (crisis), April 23: 3mg Lora daily (2nd crisis), April 27: 2,25mg Lora daily, May 12: tapered further. June 20: reached 1mg Lora daily, got WD, July 01: updose to 1,25mg Lora daily, no relief. Aug 25: updose to 1,5mg Lora daily, got better after 5 days. Dec 5: 1,7mg Lora daily, supporting last steps reinstatement paroxetine.
2024, started taper: Feb 01: 1,632mg. March 03: 1,599mg, March 24: 1,566mg. 

Intermediate metaboliser (‘bit more slow’) on CYP2D6 (*1/*4) and CYP2C19 (*1/*2). Extensive (‘normal’) on CYP3A4.

 

Edited by [Ma...]
Extensive info put in profile
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[Re...]

Hello @[Ma...], Welcome to BenzoBuddies, 

I approved your first post and with that your account. Thank you for posting your history and previous use of medication, one can definitely see you have done some serious research! Well done! :)

Please, if you have the time, copy the "Details" to the History of your profile too, so that our members will find that easier in the future. 

We have some very knowledgeable, helpful and kind members who will post on your thread soon, I am certain. 

I am going to read your post again soon, but it is getting a bit late here. 

Take care, @[Ma...]:mybuddy:

RR

 

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[sl...]

Your experience with oxa and lora remind me of my psychiatrist saying I will need 4 years to fully stop lorazepam. I was angry at him for saying that to me. I was hoping he can help me cut down sooner. 

 

I cannot give you advice as I am also a sufferer but I am on same book on the '4 years'. I have switched (or embadoned..) quite many psychiatrists over about 8 years of on/off lorazepam. I had one doctor who claimed I can do cold turkey but reading literature and medical papers I realized that doctor must be ...not the best psych around... 

Cold turkey can be life threatening by many sources right now. So I will not do it again (i did cold turkey on clorazapate many years ago, i entered HELL ...).

I think your plan is based on your previous experiences and that is why you raise your success chances. I hope the best for you because from your 'history' you have suffered a lot and you seem willing to suffer again a bit, in order to stop relying on medication.  

PS: I try to find how to add my 'history' on my profile but I don't see the 'edit profile' on my profile banner upper right:/ I am on browser on a pc. Now I go make my own thread. Again, BEST OF WISHES for your sound plan. If you base it on previous experience you will likely go well with it. Keeps us updated and..... ''bumps are not the road''.

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[Co...]

Hello @[sl...]. Welcome to BenzoBuddies.

Now that your first post has been approved, you will be able to add your History. And you can now post freely.

Glad to have you aboard! :)

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[El...]

I am also tapering lorazepam. While I cannot address all of your questions, I can speak about my experience with micro tapering. I have been micro tapering since mid September. At that time, I was at 1.268 mg (starting from 3 mg) and coming off about a 6 week hold.  I had been reducing, up until that point, at about 8-10% every 4 weeks. I decided to micro taper because it was taking me longer and longer to recover from larger cuts. I never felt well or even remotely functional. And micro tapering has really been a game-changer for me. However, there are two things I have learned in this process (and actually I have to keep relearning them, unfortunately) . They are: even though I am only making very small reductions, I absolutely have to listen to my symptoms, and, I absolutely must schedule regular holds, regardless, even if I am feeling OK. I guess I am fortunate, because I can feel if I cut too much within 12-18 hours. It seems to take considerably longer for you. Presently, I can usually reduce about 0.25% (always calculated from the last dose) for 4-5 days consecutively, then I hold for about 3 days.  This translates to a reduction of about 6% every 4 weeks.  But, inevitably, I get “cocky” and think “I am feeling so good, I’ll just do a couple of more reductions before I hold”. Or, “Surely a 0.50% cut, rather then 0.25%, won’t hurt”. But always, always, always, when I listen to that inner voice, I am slammed with debilitating symptoms and end up holding for 1-2-3 weeks instead of a few days. Last week I did a 0.50% reduction (on top of a few 0.25% cuts), and I am still feeling it. My triggers that I need to listen to are just a slight increase in my tinnitus, or my moodiness, or my headaches or my nausea. If I ignore any of these symptoms, I am in trouble. Ideally, I would hold even earlier even before I experience those triggers.

I applaud your extensive plan. I also always have a plan. And I think they are good to an extent. For me, though, sometimes I am so focused on the plan and my reduction goal for that week, that I do not listen to what my body is screaming at me. As a result, I get in trouble, followed by feeling depressed, because I think I will never finish my taper. I am now almost a year into what I had believed would be a 1-year taper. I am now realizing, and coming to terms with the fact, that I have at least 1-1 1/2 years more to go. I simply cannot go faster if I want to maintain functionality or even have a glimmer of enjoyment in life.

Hopefully, others will stop by to address your other questions and share with you their experiences with micro tapering.

Best wishes to you!

 

 

 

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[Li...]

Thank you for an insightful and helpful post @[El...]!  You’ve clearly mastered one of the most important principles of tapering.  Per Horowitz and Taylor (2024): 

 

“Ultimately, it is the patient’s experience of withdrawal that should guide the rate of taper.”

 

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[Ma...]
1 hour ago, [[E...] said:

However, there are two things I have learned in this process (and actually I have to keep relearning them, unfortunately) .

Thank you for sharing your experience and advice! 

I think you address my main concern: am I able to notice a change in symptoms before I’m to late? Because with cut/hold it takes almost a week before I really notice a change in symptoms. So how will a microtaper turn out in that case. I guess that would be trial and error.

(And: I’m a bit of a controlfreak when it comes to physical sensations, so it feels like a microtaper gives me less control.)

Also, I thought you just ‘keep microtapering and adjusting your dose as you go’. But the more I read about it, the more I see that holding/stabilizing is an essential part of it. So that’s an important new insight.

Hope a few more people will share their experiences or are able to answer some of my questions I wrote in my first post. 

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[Ma...]

My microtaper failed for 3 reasons I believe:

1. Even though it was a microtaper, i was still going too fast.  
2. I wasn’t incorporating any holds and the cuts caught up with me.  I had no idea where “stable” was once I became unstable because these drugs have long half lives in general (but maybe Lorazepam is different since it’s half life is shorter).

3. I was still taking “rescue doses” which are a big no no I have learned.  In the first few months I tapered, I was probably taking a rescue dose every week or two.  Terrible idea.  
 

I went back to cut and hold after I stabilized and am happy with the progress I’ve made since going back to that.  Who knows, I may switch to microtaper again when I get to really low doses but as long as cut and hold is working I’m gonna stick with it.  I’ve gotten down to .32 Clonazepam from 1.0.  I’ll finish when I finish.  I’m not going to rush but I’m also not going to be afraid to cut if I’m still functional.  I’m getting closer. 

 

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[El...]

I don't mean to barge in here again, but I can try to give you an idea of how you might start. Your last reduction from 0.533 x 3 per day to 0.522 x 3 per day was 0.033 (0.011 per dose) or about 2.1% overall. Clearly, if you feeling so awful, your body cannot handle that percentage all at once. Perhaps you should trial a smaller percentage…say about 1% overall. 1% would be a little less than 0.517 x 3 times per day. But instead of doing that reduction all in one go, you could spread it out over 5 days, then hold to see how you feel. So, day 1, reduce 0.001 per dose (0.521 per dose). Day 2, reduce 0.001again. You are now down to 0.52 per dose. Repeat the same for days 3-5. Each days reduction is now about 0.19% and perhaps not so taxing. Now hold and see if your symptoms flair as they have in the past. If they do, reduce your percentage again, but only after you have stabilized. If your symptoms do not flair, either keep the same percent reduction or increase it. You are correct, this is, indeed, trial and error. And it can be painful, or hopefully, best case, not painful. And, it can also be very liberating to ultimately have control over your symptoms.

Again, wishing you well.

 

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[Ma...]

Thanks Ellie! I’m still holding, waiting a bit more and hoping to return to the baseline I had after the previous steps. And then: collecting courage to try another way of tapering.

 

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[Ma...]
On 14/04/2024 at 21:02, [[M...] said:

Q B|   What is prefered: doing a watertaper with solving a tablet (suspension) or solving a liquid (dilution)? The only Lora-liquid available in Holland is 1mg/ml (compounded pharmacy).
Q C|   Cut and hold is pretty clear: make a cut, wait 'till symptoms get better, make a next cut. But how does this work with microtaper? Do the symptoms keep piling up without any form of stabilisation? And if you want to stabilise, is there a risk of being 'to late' because of the cumulations of symptoms?
Q D|   What is the risk of reaching tolerance (-withdrawal) when doing a microtaper?
Q E|   What is better for avoiding protracted withdrawal after reaching zero: cut and hold or microtaper?
Q F|   What reasons do people have to not do a microtaper or go back to 'cut and hold'? 

Ellie gave me some good advice on short term options for tapering to 0,5mg. I was wondering if there are others who can give me some guidance/answers on my other questions. Is there someone I can tagg  (or isn’t that appropriate here)?


I’m in my fourth week now after doing a 2% step. I think the acute withdrawal symptoms I also had with the previous steps are settling down (no more nightmares, cortisolrush in the morning, waves of anxiety, moments of panic, higher heartrate, lower HRV).

But I’m beginning to worry that I might be going into tolerance-withdrawal because some symptoms are not going away or seem to get worse: depression, crying, chestpressure and a wobbly feeling in the back if my head. So that’s starting to freak me out a bit.

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[Li...]
10 hours ago, [[M...] said:

Ellie gave me some good advice on short term options for tapering to 0,5mg. I was wondering if there are others who can give me some guidance/answers on my other questions.

Hello @[Ma...]. I can address three of them:

Q B|   What is preferred: doing a water taper with solving a tablet (suspension) or solving a liquid (dilution)? The only Lora-liquid available in Holland is 1mg/ml (compounded pharmacy).

The preferred method is the one that works for you!  However, generally speaking, a professionally prepared, stability-tested liquid is more likely to yield accurate and precise doses than a do-it-yourself liquid.

Given that you are in The Netherlands, have you considered Tapering Strips?  

Q D|   What is the risk of reaching tolerance (withdrawal) when doing a microtaper?

Unknown at this time

Q E|   What is better for avoiding protracted withdrawal after reaching zero: cut and hold or microtaper?

Unknown at this time

Edited by [Li...]
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[Ma...]
1 hour ago, [[L...] said:

Hello @[Ma...]. I can address three of them:

Q B|   What is preferred: doing a water taper with solving a tablet (suspension) or solving a liquid (dilution)? The only Lora-liquid available in Holland is 1mg/ml (compounded pharmacy).

The preferred method is the one that works for you!  However, a professionally prepared, stability-tested liquid is likely to yield more accurate and precise doses than a do-it-yourself liquid.

Given that you are in The Netherlands, have you considered Tapering Strips?  
 

Thank you Libertas! I considered them, but for Lora the lowest dose in the strip is 0,05mg. That is too big of a step. Plus: with three doses a day, it would become pretty expensive.

So, I’m now on a pro-prepared liquid of 1mg/ml (only one available) and mix this with water. To me that feels a bit more trustworthy then mixing a pill with water that doesn’t desolve completely. What’s your idea on this? Or does it make no difference, as long as you give it a good shake to spread evenly in the water?

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[Li...]

You’re welcome @[Ma...].  It’s difficult to respond to your question without knowing the formulation of the 1m/mL compounded liquid.  For example, is it a solution or a suspension?  What is the source of the active ingredient (i.e. the lorazepam) —  regular tablets or bulk powder?  What are the other ingredients?  

A group of pharmacists in The Netherlands developed a 1mg/mL oral lorazepam solution a few years ago.  I wonder if this might be the formulation?  See citation and ingredients below.

Also, how much water are you adding to how much of the liquid to dilute it?

Given that you’re adding water, it’s possible the resulting liquid may indeed be a suspension (even if it’s a solution in undiluted form).  So shaking the diluted liquid before you measure a dose is wise. Also, per the article below, lorazepam is subject to hydrolysis — if you are not already doing so, I suggest making smaller rather than larger batches.

Citation:
Vossen, A.C. & Velde, I. & Smeets, O.S.N.M. & Postma, D.J. & Eckhardt, M. & Vermes, A. & Koch, Birgit & Vulto, Arnold & Hanff, L.M.. (2017). Formulating a poorly water soluble drug into an oral solution suitable for paediatric patients; lorazepam as a model drug. European Journal of Pharmaceutical Sciences, pp. 205-210.

Ingredients:
lorazepam API (Active Pharmaceutical Ingredient), glycerol, polyethylene glycol 400, propylene glycol, orange essence

 

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[Ma...]

@[Li...] I think this is the one I have. Will check when I’m home in few hours.

I have a 0,5 tablet (just take that with water) and the dilution. 
Dilution is 1mg/ml.

The two drops (are 0,066mg) are mixed with 1,2ml in a tiny bottle. I give it a good shake and take 0,4ml out with the syringe. And take what’s in the syringe. 
I make each dose at the time I need to take it. So no batches in the fridge or something.

This night was though…. Left side of my brain is wobly, music in loops, there’s sort of panic in the left side of my body, I feel ‘revved up’, depression and suid ideation is huge… I’m so worried because I seem to get worse last 2/3 weeks… I seem to get new symptoms along the way. I’m just really scared…. 😞

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[Li...]

@[Ma...]

I’m sorry you had a difficult night and your symptoms seem to have gotten worse over the past 2 - 3 weeks.  Let’s check your taper rate.

  1. Are the dates and doses in your History correct? (e.g. you began your taper on January 1 at a total daily dose of 1.7mg)
  2. What was your total daily dose on April 1?
  3. What was your total daily dose yesterday, April 18?

Now let’s make sure we are understanding how you are making and using the diluted liquid.  For yesterday’s total daily dose:

  1. What was the concentration of the diluted liquid in mg/mL?  
  2. How many milliliters of the diluted liquid did you ingest in total for the day? 
  3. In addition to ingesting the diluted liquid, is it correct that you also ingested 1.5mg of lorazepam in tablet form?
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[Ma...]

@[Li...] 

Here are the ingredrients of the compounded liquid 1mg/ml (bottle 100ml, dispose 4 weeks after opening):

orange essence 0,10000 gram, glycerol 85% Ph. Eur. 108,10000 gram, Lorazepam 0,10000 gram, macrogol 400 10,00 gram, propylenglycolum 3,00000 gram. 

And here are the taperingdetails.

Before taper: total daily 1,698mg = 3 times 0,566mg (just 0,5mg tablet and 2 drops from syringe)


Feb 1: total daily 1,632mg = 3 times 0,544 = 4% drop from 0,566 = (tablet + (2 drops+1,2ml water, take 0,8ml))
Week 1 and 2: symptoms started day 4, lot of bodypain, stiffness, muscle twitches, cortisolrush, more emotional, waves of anxiety, higher heartrate, low HRV

Week 3: fatique, burning sensations, pressure stomach, brainfog, sore throat

Week 4: sudden onset of severe depression, suic. ideation, shivers, flushed head

All ‘normal’ again at day 28 before next step.

 

March 3: total daily 1,599mg = 3 times 0,533 = 2% drop from 0,544 = (tablet + (2 drops +1,2ml water, take 0,6ml))

Week 1: pretty okay week, minor cortisolrush, burning sensations, real symptoms started day 6/7

Week 2 and 3: feeling bit flu-ish, burning sensations, fatigue, stiffness unwell when waking up, cortisolrush, last few hours of sleep are restless

All ‘normal’ again at day 19.

 

March 24: total daily 1,566mg = 3 times 0,522 = 2% drop from 0,533 = (tablet + (2 drops+1,2ml water, take 0,4ml))
Week 1: pretty okay week, anxiety, less spontaneous appetite, real symptoms started day 6/7

Week 2: higher heartrate, low HRV, stiffness, chest pressure, fatigue

Week 3: nightmares, last hours of sleep restless

Week 3 and 4: intens pressure stomach, severe pain mid-back or pelvis, dread, obsessive, frustration, crying, waking up with minor heatflash, 2/3 times restless leggs for brief moments, severe depression, suic ideation -> seem to get worse last few days,

Week 4:  last two days: less pressure stomach, less pain back or pelvis, less frustration. New symptoms: music-loops, wobbly/ dizzy feeling in leftside head, difficulty falling asleep because of feelings leftside brain, waking up with sort of stress/panicy feel in left side body.


I do this 3 times a day, so making no dilution prior to taking it. ‘Fresh’.

So from Jan 31 till today I did a total of minus 7,773%. 

 

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[Li...]

Thank you for sharing the ingredients in the compound you are using @[Ma...]. That sounds like the formulation I referenced upthread.

My apologies but I am having difficulty following your posts (too much information/text). 

Would you be so kind as to answer only the questions below in the order I’ve asked them?

Let’s check your taper rate.

  1. Are the dates and doses in your History correct? (I.e., you began your taper on January 1 at a total daily dose - TDD - of 1.7mg; on Feb 1 your TDD was 1.632; on Mar3, 1.599; and on Mar 24, 1.566).
  2. What was your total daily dose on April 1?
  3. What was your total daily dose yesterday, April 18?

Now let’s make sure we are understanding how you are making and using the diluted liquid.  For yesterday’s total daily dose:

  1. What was the concentration of the diluted liquid in mg/mL?  
  2. How many milliliters of the diluted liquid did you ingest in total for the day? 
  3. In addition to ingesting the diluted liquid, is it correct that you also ingested 1.5mg of lorazepam in tablet form?
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[Ma...]
Posted (edited)

@[Li...] I will! Sorry, maybe a bit of oversharing. I hope I understand your last three questions correctly and give you the info you're looking for.

  1. Method: cut and hold
    Before taper: TDD 1,698mg (3x 0,566mg)
    Per Feb 1: TDD 1,632mg (3x 0,544mg)
    Per March 3: TDD 1,599mg (3x 0,533mg)
    Per March 24: TDD 1,566mg (3x 0,522mg)
  2. TDD April 1: 1,566mg 
  3. TDD April 18: 1,566mg
  4. Compounded liquid is Lora 1mg/ml, 2 drops is 0,066mg. My dilution is 0,066mg/1,2ml.
  5. Per dose: 1,2ml water + 2 drops compounded liquid --> mix it --> I ingest 0,4ml per dose, which would be 0,022mg. That times 3 a day.
  6. 1,5mg TDD tablets is correct.

Since tapering no changes made in syringes, method, times.

Edited by [Ma...]
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[Li...]

Thank you @[Ma...].  This is much easier to follow.  It is quite common for members to make mistakes in math and/or measurement (M&Ms) so I wanted to double-check the basics first before moving to the next stage of troubleshooting.  Your M&Ms check out so tip of the hat.  

(You might want to add a note to your History that you have been holding your TDD at 1.566mg since March 24.)

How did you feel before you started your taper (when you were taking a TDD of 1.698mg)? Were you experiencing withdrawal symptoms?  If so, were the withdrawal symptoms tolerable?  Stable (i.e. not changing in number or nature)?

Your taper rate has been quite conservative (the last two reductions were in the range of 2%).  Have you made any other changes in medications?  Supplements?  Are you experiencing other health issues?  Stressors at home or at work?

I must work on another project so won’t be able to respond for a while.I hope other members will stop by to offer input.

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[Ma...]

Hi @[Li...], it's hard to answer the question of how I felt before starting the benzo taper.
I had severe withdrawal syndrome last year from a very slight taper of Paroxetine. That's how I ended up on Lora. There was a first taper and slight updoses in Lorazepam last year. All dates and details are in my profile and visuals in attachement.
In september I micro-wise reinstated the Paroxetine to my old dose from January 2023. I think I recovered for about 80-90% from Paroxetine withdrawal. I wasn't fully symptom free starting the Lora-taper.


During the Lora-taper I might have had the two best weeks (although not symptom free) since Jan-Feb 2023. Those were: first week after cutting to 0,533 and first week after cutting to 0,522.
But: both times I was stable from symptoms after the prior cuts. 
But it questions me why I seem to get worse / have other symptoms last 2-3 weeks. 
I did try (once) 200mg MagnesiumCitrate at 9/10 april if I remember correctly, to relief pain. But in my idea it didn't do anything. 


But I guess looking back at last year, it could be I also developed some tolerance for Lorazepam. I can't tell for sure. I would go into sudden depression with SI and crying (along with worsening of other symptoms). But it is hard to say what the cause was. Both updoses from Lora (August 25th, December 5th) relieved the depression and SI. Not the other symptoms.
Attached a file for visuals (keep track ever since March 2023, personal version has a lot more info).
('good' = withdrawal good, 'okay' = withdrawal okay)

Kopie Engels.xlsx

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[Li...]

@[Ma...] Nothing is jumping out as a possible explanation for why you seem to have gotten worse over the past 2-3 weeks.  It could be you’re just in a ‘wave’ that will pass or it could be a resurgence of effects from your paroxetine taper and reinstatement (see quote below from Adele Framer, founder of SurvivingAntidepressants, about paroxetine).  Or it could be something else entirely.  

As I’m sure you have learned, benzodiazepine withdrawal has many twists and turns. I hope other members will stop by to offer their thoughts.

Framer (2021) on paroxetine:

“As noted many times in the literature, patients find tapering paroxetine to be extraordinarily difficult. Many are stymied at a dose lowered to 5 mg or less. A powerful inhibitor of its own metabolism, paroxetine dosage decrease accelerates its processing, which amplifies the decrement to evoke severe withdrawal symptoms.”

Framer A. What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications. Ther Adv Psychopharmacol. 2021 Mar 16.

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[Ma...]

@[Li...] want to thank you for your time, trying to figure things out! 
I hope things will progress in the next few days 🤞🏻

Wishing you well on your other project! 

And yes, Paroxetine is the dev*l itself… Unbelievable what a mess that made last year… I guess that still influences the sensitivity from my nervous system while tapering Lora.

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  • 4 weeks later...
[Ma...]
Posted (edited)

Asking for advice microtaper

Last time I posted (April 20th) I was having a really bad two weeks. Especially April 22-26 was pretty bad: I was very depressed and had constant intrusive suic.-thoughts. It was the third or fourth time experiencing this after a step in my taper. Only this time the depression was a week longer than prior moments. And that scared me.

I decided to do a microtaper after that. Minus 0,5% per 5 days, making 2% every 20 days. Before I was making 2% cuts at once, every 3-4 weeks.

With normal 2% cuts at once, week 1 was good, week 2 got worse, week 3 was bad and week 4 was the toughest. And then all cleared in few days and I would make the next cut. 

I’m now at day 20 of my microtaper experiment. So far my weeks have been better compared to the prior 2% cuts. So far, so good. Better sleep, less cortisolrush in morning, no nightmares, no stomachpressure of severe backpain, no depression or suic-thoughts.

I guess that’s because I came from a stabile position (healed from last cut) and then started the microtaper, so had a very slow ‘build up’.

But since yesterday the burning sensations and chestpressure seem to get worse. It’s tolerable and could be worse, but makes me question.

 

Questions

- With this microtaper, is it possible that the effects of the microcuts are cumulating to a certain point? That the  steps are quicker than my nervous system is healing? 

- How to know when to stabilize a few extra days? With a normal cut, you just ‘wait’ and things are very clear it was about the last cut you made. With this microtaper I’m not sure.

- Is is possible that with a constant microtaper, you stay in a constant ‘withdrawal state’ in stead of cutting and stabilizing?

I guess I’m a bit afraid of either being ‘too late’ with stabilizing if needed or being ‘too carefull’ and missing the chance to see what happens if I take my next microcut tomorrow. 

And also: with the microtaper I had the secret hope to go 2% every 3 weeks in stead of 4/4,5 weeks. Then it would take me 3 years to be done in stead of 4….

Edited by [Ma...]
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[El...]

I am so glad your microtaper seems to be working!

It has been my experience that, yes, your body needs a period to “catch up” from a cumulative series of cuts. This would suggest, that after 20 days of microtapering and the recent increase in your symptoms, that your body is telling you that it does need to “catch up”. The problem you are facing, and one which we all face, is that we are both the chief investigator and the subject of this experiment, which is tapering. I am not in your place. But, I have found that I must schedule in regular holds, even if I am feeling well. For me, it only takes one day to go from feeling “OK” to feeling “rotten”. When I last replied to your thread, I was scheduling regular holds of 3 days after every 5 days of tapering. I have now been able to extend it to holding for 3 days after every 10 days of tapering. That is what is working for me NOW. I might be able to extend it to 12 days, or I might need to go back to holding every 5 or 6 or 7 or 8 days. I just have to listen to my body very closely and not gaze too keenly into the future (lest I become depressed about the length of the taper). For me, I think getting off this medication in “relative comfort “ is more important that getting off it 3-6 months earlier that I had hoped and planned.

Best wishes to you!

 

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