Ohh this isn’t good.

[[Co...]]

3 minutes ago, [[t...] said:

I have suffered crippling depression since the wd 3 weeks ago. Now it is way worse. 
doc appointment today. Please give me something that I can ask her for. This is bad 

I (and we) cannot do this (and I've never even taken an antidepressant). Members might be able to tell you what they have taken and what worked for them. But we are individuals in unique circumstances. What works for them, might not be optimal for you, and vice versa.

My advice is to be as clear as possible with your doctor in detailing what's been happening. And discuss all the options, and potential risks vs potential benefits.

[[Ka...]]

Just reading @[th...] I do concur with @[Co...]

Also, I wonder if your previous accuracy with cutting was adrift & may now be possibly affecting you?

It’s really important you convey your experience to your doctor in as much detail as you can. The advice given yesterday I think was this is paradoxical when this looks to be interdose related. 

[[th...]]

17 minutes ago, [[C...] said:

Ah. That's not paradoxical effects. A paradoxical effect is one which is opposite the intended effect of the medication. And such paradoxical effects occur/worsen a short time ofter the dose, when blood levels of the medication rise.

You appear to be suffering more from interdose effects, where you are suffering from heightened withdrawal effects before your next dose. The fact that you suffer less when you take your larger 1mg dose at night is indicative of this too.

This is better news. When suffering from paradoxical effects, the only viable solution is to withdraw as quickly as practicable (while remaining safe). To be clear, this does not appear to describe your situation.

 

2 minutes ago, [[K...] said:

Just reading @[th...] I do concur with @[Co...]

Also, I wonder if your previous accuracy with cutting was adrift & may now be possibly affecting you?

It’s really important you convey your experience to your doctor in as much detail as you can. The advice given yesterday I think was this is paradoxical when this looks to be interdose related. 

Issue is she is being led by me and I don’t know what to do or tell her. It’s like when I take it, I still feel anxiety and adrenaline surges. I don’t know about switching, I don’t know what to do about the interdose. I don’t know how to taper this, I don’t know what to say. She is a NP and has no clue about benzo but she is all we have in our small town. 

[[th...]]

I think I’m not allowed to updose because that too will become tolerant, but I can’t get stability and I can’t survive doing this water taper. 

[[Co...]]

26 minutes ago, [[t...] said:

Issue is she is being led by me and I don’t know what to do or tell her. It’s like when I take it, I still feel anxiety and adrenaline surges. I don’t know about switching, I don’t know what to do about the interdose. I don’t know how to taper this, I don’t know what to say. She is a NP and has no clue about benzo but she is all we have in our small town. 

There are two possible approaches. As has already been mentioned, you might switch to a longer-acting benzodiazepine. Another approach would be to take more, but smaller doses over the day which add up to a similar total daily dose (a prescription for liquid Xanax would aid this). Though, this does not work over night of course, so it is not ideal.

Or, you might take a long-acting version of Xanax. But the problem with these pills is that they are totally unsuitable for water titration (or even simple pill-splitting).

In the circumstances, it might be wise to discuss with your doctor the possibility of switching to a longer-acting benzodiazepine.

[[Co...]]

16 minutes ago, [[t...] said:

I think I’m not allowed to updose because that too will become tolerant, but I can’t get stability and I can’t survive doing this water taper. 

If you have become tolerant of lower dose, you likely will become tolerant of an increased dose too. In fact, given enough time, it is usual to develop tolerance of whatever dose of benzodiazepine we take.

[[th...]]

@[Co...] will I have to taper the Xanax to a longer acting or a complete switch? 

[[th...]]

My NP is led by me and I don’t know what I’m doing. She has me lead by asking her what I needed to taper. But I’m at the part now where I don’t know what to say to her today. I think I’m going to ask for propranolol but I need a longer acting benzo but I don’t know if you can just take a different type and it be ok without taking half a Xanax with it and decreasing the Xanax. I know I legally can’t get two benzo scripts 

[[Li...]]

1 hour ago, [[t...] said:

I know I legally can’t get two benzo scripts 

Are you certain of this?  I am not familiar with West Virginia rules and regs but a quick scan of the below-linked sources did not reveal any statements to this effect:

(1) Pharmacy Laws and Legislative Rules of West Virginia Governing the Practice of Pharmacy Controlled Substances Act (2023)

(2) West Virginia Code | §60A-3 | on Dispensing Controlled Substances

[[th...]]

I was not aware! But I have only been doing the water taper 1ml out but I can’t do it with Xanax. 

[[Ma...]]

I think you have two options:

- more frequent dosing covering 24 hours a day. Do that for two weeks and then start watertapering all dosis by minus 0,5ml every two/three days to start with.

- do a switch Ashton style. So not an abrupt switch, but getting f.e. Valium in the mix in 1-2 weeks and slowly lowering the Xanax.

I think there are no other options then these two. And both take days to settle down I guess.
And: I would search for non-medicine options of coping. There are plenty online options for gentle yoga, meditation, breathing excercises. And offline like taking a walk, cook healthy, drink enough water, distract by being creative/ watching a movie/ reading.

We’re all in the rollercoaster of soooo not wanting this to happen. But is is happening, so we have to find a way to survive and be as comfortable as possible given the circumstances.

You have to make a choice for one of the options, even when you don’t know how they turn out. We’re all crossing our fingers for you!! 🌸

[[th...]]

I took a genetic testing and Valium is marked under moderate interaction… my doc appointment is in 4 hours and I don’t know what to say 

[[Li...]]

42 minutes ago, [[t...] said:

I was not aware! But I have only been doing the water taper 1ml out but I can’t do it with Xanax. 

There’s considerable incorrect information floating around the internet about what is/is not allowed in terms of dispensing controlled substances.  Moreover, laws, rules and regs vary from state to state.  Consequently, It’s preferable to consult credible primary sources such as the ones above concerning such matters. 

Just checking … are you familiar with these resources:

Benzodiazepines: How They Work & How to Withdraw, Prof C H Ashton DM, FRCP, 2002. Available for free at: https://www.benzo.org.uk/manual/bzsched.htm

The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs by Horowitz and Taylor (2024). KIndle version available from Amazon at https://a.co/d/4laVDhd

[[th...]]

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

There’s considerable incorrect information floating around the internet about what is/is not allowed in terms of dispensing controlled substances.  Moreover, laws, rules and regs vary from state to state.  Consequently, It’s preferable to consult credible primary sources such as the ones above concerning such matters. 

Just checking … are you familiar with these resources:

Benzodiazepines: How They Work & How to Withdraw, Prof C H Ashton DM, FRCP, 2002. Available for free at: https://www.benzo.org.uk/manual/bzsched.htm

The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs by Horowitz and Taylor (2024). KIndle version available from Amazon at https://a.co/d/4laVDhd

I found my gene site and it says the Diaz. I have an interaction with and serum levels will be too high so a low dose is required and now I don’t know if I need to switch to a longer lasting like Kolodipin 

[[PE...]]

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

My NP is led by me and I don’t know what I’m doing. She has me lead by asking her what I needed to taper. But I’m at the part now where I don’t know what to say to her today. I think I’m going to ask for propranolol but I need a longer acting benzo but I don’t know if you can just take a different type and it be ok without taking half a Xanax with it and decreasing the Xanax. I know I legally can’t get two benzo scripts 

Somencan just switch and be fine. I did many times and as long the doses was equally strong, 1mg xanax aprox 10mg diazepam? I was fine. I belive it's easier to taper with a long acting one. Less fuzz!

https://acrobat.adobe.com/id/urn:aaid:sc:EU:464620d2-f069-45cf-a634-c30cb6c39330

[[th...]]

That’s exactly what I need is something longer. Within an hour I’m back to anxiety and wds because I’m already in tolerance with Xanax so now it’s just messing my body up and it’s only day two. 

[[PE...]]

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

That’s exactly what I need is something longer. Within an hour I’m back to anxiety and wds because I’m already in tolerance with Xanax so now it’s just messing my body up and it’s only day two. 

Perhaps switching to 20mg diazepam and see if you can stabilize?

[[th...]]

4 hours until appointment and I need to be able to tell her something but I’m so new to all this and this hit fast. Tolerance hit fast, the water taper with Xanax is giving me maybe 30 minutes of slight calm but then it’s gone and I’m back in withdrawals. I don’t think I can do Diaz. Due to interaction or I just need a lower one. But how do I even have a nurse practitioner to calculate that. They are the ones that got me on… 

[[th...]]

1 hour ago, [[L...] said:

There’s considerable incorrect information floating around the internet about what is/is not allowed in terms of dispensing controlled substances.  Moreover, laws, rules and regs vary from state to state.  Consequently, It’s preferable to consult credible primary sources such as the ones above concerning such matters. 

Just checking … are you familiar with these resources:

Benzodiazepines: How They Work & How to Withdraw, Prof C H Ashton DM, FRCP, 2002. Available for free at: https://www.benzo.org.uk/manual/bzsched.htm

The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs by Horowitz and Taylor (2024). KIndle version available from Amazon at https://a.co/d/4laVDhd

No i was not. I’m very very new and in a bit of a pickle with Xanax lasting 4 seconds (joking) in a water suspension and then back into rebound. 

[[Bo...]]

Hi there, I just want to chime in and if you have a moderate interactional Valium and you need a lower dose of it for your serum that means you don’t clear it very well so from what I’ve read on these boards from people that are slow metabolizers meaning they need a lower serum level I would strongly consider not switching to Valium .

 

I highly recommend downloading the book that Libertas mentions it is Dr. Mark Horowitz, who is a psychiatrist put this together for practitioners to use as guidance to help people come off of and taper their benzodiazepines and antidepressants. You can order quickly and view it on your Kindle on Amazon. And you can pull this up on your phone or  iPad at the doctors appointment.

https://www.amazon.com/Maudsley-Guidelines-prescribing-Prescribing/dp/111982298X

This will be helpful also for your nurse practitioner because she might feel well. She will feel much more knowledgeable about reviewing this information and it’s basically the Harvard equivalent of guidelines because they use the Maudsley for prescribing these medication so now this exists for prescribing which is gonna be very helpful for the medical community.
It’s great for patients too because we can educate ourselves and be informed.

Try not to panic I know easier said than done,  many people have been in your situation so we know exactly how you’re feeling and what you’re going through.

What has been learned is staying with the medication you’ve been on if you canhelpful, just because you never know transferring to another one of these benzos how it’ll go until you’re trying to make the switchpeople we get caught between two benzos and then it’s even more of a nightmare.

After detailing this all out, and I’ve tried to read through the wholeit appears like Colin said that you are having interdose withdrawal and sometimes people have to dose 4 to 5 timesFor Xanax.
jenn Swanktowski a Therapist going through this I doses her Xanax five times a day. She has a YouTube channel that’s very helpful for symptoms coping strategies etc you can maybe look at once you get your plan sorted.

https://m.youtube.com/@jenniferswanphd/videos
 

 

 

Edited April 17 by [Bo...]

[[th...]]

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

Hi there, I just want to chime in and if you have a moderate interactional Valium and you need a lower dose of it for your serum that means you don’t clear it very well so from what I’ve read on these boards from people that are slow metabolizers meaning they need a lower serum level I would strongly consider not switching to Valium .

I highly recommend downloading the book that Libertas mentions it is Dr. Mark Horowitz, who is a psychiatrist put this together for practitioners to use as guidance to help people come off of and taper their benzodiazepines and antidepressants. You can order quickly and view it on your Kindle on Amazon. And you can pull this up on your phone or  iPad at the doctors appointment.

https://www.amazon.com/Maudsley-Guidelines-prescribing-Prescribing/dp/111982298X

This will be helpful also for your nurse practitioner because she might feel well. She will feel much more knowledgeable about reviewing this information and it’s basically the Harvard equivalent of guidelines because they use the Maudsley for prescribing these medication so now this exists for prescribing which is gonna be very helpful for the medical community.
It’s great for patients too because we can educate ourselves and be informed.

Try not to panic I know easierso many people have been in your situation so we know exactly how you’re feeling and what you’re going through.

What has been learned is staying with the medication you’ve been on if you canhelpful, just because you never know transferring to another one of these benzos how it’ll go until you’re trying to make the switchpeople we get caught between two benzos and then it’s even more of a nightmare.

After detailing this all out, and I’ve tried to read through the wholeit appears like Colin said that you are having introduce withdrawal and sometimes people have to dose 4 to 5 timesFor Xanax. Jenn Swanktowski a Therapist going through this I doses her Xanax five times a day. She has a YouTube channel that’s very helpful for symptoms coping strategies etc you can maybe look at once you get more stable.

So I shouldn’t switch to a longer acting one… not klonopin?

[[Bo...]]

That’s a choice you’re gonna have to talk about with your nurse practitioner, but I don’t believe from what you’re detailing that you’re having paradoxical effects from the Xanax I think again like Colin mention it’s more of an interdose issue 

And you can figure this out quickly by trying four or five doses a day instead of the three. It’s more prevents having such intense symptoms because you’re counteracting interdose issues then you’ll be feeling much more stable and it won’t be such a pain because you want the stability.

If Klonopin is genetically and doesn’t have any issues with your genes it is an option if you still want to pursue that but considering trying out couple more doses with the Xanax to see if this can be sorted and staying on some thing and not having to worry about to a new med just takes out potential complications trying to crossover.

That kind of can be your last resort and it’s good to know that it’s in your Jean category, but sometimes the genetic aren’t all predictive what and how someone’s going to respond. People might still have side effects even in the green use as directed category. The test are not full proof.
 

 

[[th...]]

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

That’s a choice you’re gonna have to talk about with your nurse practitioner, but I don’t believe from what you’re detailing that you’re having paradoxical effects from the Xanax I think again like Colin mention it’s more of an interdose issue 

And you can figure this out quickly by trying four or five doses a day instead of the three. It’s more prevents having such intense symptoms because you’re counteracting interdose issues then you’ll be feeling much more stable and it won’t be such a pain because you want the stability.

If Klonopin is genetically and doesn’t have any issues with your genes it is an option if you still want to pursue that but considering trying out couple more doses with the Xanax to see if this can be sorted and staying on some thing and not having to worry about to a new med just takes out potential complications trying to crossover.

That kind of can be your last resort and it’s good to know that it’s in your Jean category, but sometimes the genetic aren’t all predictive what and how someone’s going to respond. People might still have side effects even in the green use as directed category. The test are not full proof.
 

I think where I am confused is even when I was taking my full amount of Xanax, I was still shaking and having adrenaline surges. Just bam, 3 weeks perfect one night I took the 1mg sat on the couch with my favorite show “ It’s always sunny in Philadelphia” and I was like, why am I rubbing my legs together.. wait, why do I feel this anxiety. In all the years on it, I had no idea why it just simply stopped. I think that’s when panic set in, then trying to taper it is absolutely horrible. Such a short short short half life and when you reach tolerance on it, it’s even shorter. I think in the panic I felt that when I took it, it made me worse (really it just doesn’t work the same anymore) but water tapering it is god awful. The life is even shorter. It’s like you drink it, feel it slightly, then bam back in to shaking. 

[[Co...]]

1 hour ago, [[t...] said:

4 hours until appointment and I need to be able to tell her something but I’m so new to all this and this hit fast. Tolerance hit fast, the water taper with Xanax is giving me maybe 30 minutes of slight calm but then it’s gone and I’m back in withdrawals. I don’t think I can do Diaz. Due to interaction or I just need a lower one. But how do I even have a nurse practitioner to calculate that. They are the ones that got me on… 

If you feel that Valium would be a poor choice for you, as has already been discussed, Klonopin might be an option.

It is sensible to gradually change over over some weeks. @[PE...] mentioned that some people manage to switch in a single step without too many problems - this is true - but I do not recommend the approach if it can be avoided.

[[th...]]

I don’t know how to cross taper and I know she won’t either 

@[Co...] but also I just read it is harder to come off of than Xanax during wds? 

Edited April 17 by [th...]