Protracted Withdrawal Explained for Doctors (revised version)

[[Li...]]

Perhaps of interest …

 

[[ne...]]

Crap. Informative but scares me when he states the percentages that can be years out. At 16 months with a lot of symptoms still I get so nervous. 

[[Li...]]

@[ne...] I hear you but you might want to keep in mind that the rough estimates provided are based on JWD’s observations of his own clinical practice (i.e. not research).  His practice is relatively new and my understanding is he tends to get the more difficult cases.

I know it’s challenging to do, but I encourage you to focus on the positive messages in the video.  For example:

“This condition can be incredibly painful and uncomfortable, but it is not progressive and it actually has a good prognosis ….”

”All patients appear to gradually improve over time.”

[[Bu...]]

Thanks @[Li...],

I think I'll take this one to my follow up doctor appointment.

I was wondering though, in the beginning of the video he says this occurrs in Cold Turkey cases, but I wasn't a ct, just a crummy too-fast taper.  I am searching his videos to see if he addresses this.  Do you know of any off-hand that do?

 

[[Li...]]

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

Thanks @[Li...],

I think I'll take this one to my follow up doctor appointment.

I was wondering though, in the beginning of the video he says this occurrs in Cold Turkey cases, but I wasn't a ct, just a crummy too-fast taper.  I am searching his videos to see if he addresses this.  Do you know of any off-hand that do?

You’re welcome, @[Bu...].  If you do decide to share this with your doctor, I hope you’ll let us know how it is received. 

Re: JWD videos that address possible injury from a too rapid taper …

I don’t recall any off hand, but if memory serves, there’s at least one other video that addresses protracted withdrawal so you might check there.

Also, the potential harm of a too rapid taper is addressed in a roundabout way toward the end of this video. Specifically, in the segment where he responds to the question — “How do I prevent protracted withdrawal injury from occurring?” (ts: 9:35m). He stresses the importance of implementing a gradual, symptom-guided taper and refers to The Maudsley Deprescribing Guidelines (Horowitz & Taylor, 2024).

[[re...]]

I think Horowitz is a HERO and he is the new Ashton. And not to discredit the tried and true Ashton Manual. But I can't help it. I just love this guy because he was a victim and on BOTH sides of this mess being a psych doc and all that. He seems (obviously) to have gotten major pushback from his peers when he started to make the discoveries on tapering and the hyperbolic taper stuff as well. That receptor occupancy theory seems so legitimate to me and needs more funding behind if it could be a real thing

I would so so love there to be real RCTS with this kind of taper. I mean full eeg readings. sleep studies, etc throughout the taper and the whole thing. And even after the jump. It could give us all such insights into the real possible  importance of this kind of taper. 

[[Li...]]

@[re...] Might I offer a point of clarification?

 

I have tremendous respect and admiration for Dr. Horowitz’s work as well as that of his colleague and co-author Dr. Taylor (whose name is all too infrequently excluded in references to The Maudsley Deprescribing Guidelines).  My understanding (which may, of course, be incorrect) is that the key concepts/principles underlying hyperbolic tapering have been known for quite a while (e.g. that the binding curves of psychiatric drugs to brain receptors are hyperbolic in shape).  Horowitz and Taylor’s noteworthy achievement was to synthesize and eloquently articulate these key concepts/principles in a paper published in one of the world's highest-impact academic journals (The Lancet) in 2019.  (You might find it of interest to learn that Horowitz and Taylor cited Heather Ashton’s work in their paper.)

I share your hope that Randomized Controlled Trials of the effectiveness of hyperbolic tapering in helping individuals safely and successfully discontinue benzodiazepines will be conducted.  At this time, I am aware of two completed studies about hyperbolic tapering of antipsychotics and a third study comparing hyperbolic tapering of antidepressants to usual care currently underway.

 

[[re...]]

Thank you Libertas for that detailed explanation. You have done your homework well. 

I thank you for it and will look more in depth at the reference points you have stated. 

Much appreciated

[[Li...]]

You’re welcome @[re...].  If you come across any research studies about hyperbolic tapering of benzodiazepines, please let us know!

Here’s a link to the abstract for Horowitz and Taylor (2019): 

Tapering of SSRI treatment to mitigate withdrawal symptoms - The Lancet Psychiatry

 

Here’s a response to the above paper by a group of Dutch researchers who had, independently of Horowitz and Taylor, also proposed reducing doses of SSRIs or SNRIs hyperbolically.

 

[[Ma...]]

Hero

[[Li...]]

Interesting.  The above video is still viewable but has been unlisted.  My guess is JWD may be having it re-edited in response to the viewer comment now pinned to the top of the comments section:

 

“When you do another PSA, could you do [a] version without the patient intro? Maybe lose the high contrast type cross-wipes, sensational stock videos and look directly into one camera. This might work for 25 yr old interns, but older doctors, who are the most hesitant to change, won’t take this seriously.”

 

[[re...]]

Hey Libertas if you don't mind me asking and you seem real in tune with the gaba receptor theory. How did you taper once you got below 1 mg valium. I believe you did a homemade solution based water/vodka micro taper?

I have done a water suspension without stirring just agitation with a spoon for each pass of my syringe in the water with decent results thus far. Not great but have made it down to .80 and still functional and sleeping decent (thank god) quite symptomatic, but not debilitated at all. 

Do you think there is a Placebo effect at these low low doses. 

[[re...]]

I understand the receptor occupancy hyperbole curve. But like under 1 mg valium how steep is this curve. Is it steeper from 2-1mg? It seems many have problems with this reduction area. 

[[Li...]]

@[re...]  Let’s keep this thread focused on the video.  If you’ll start a New Topic with your questions, I’ll respond there later today or tomorrow (I have another project I must work on first).  In the interim, please be aware that my benzo experience is with clonazepam not diazepam/Valium and my experiment with the vodka/water homemade liquid was a complete failure. I switched to a professionally compounded liquid.

[[re...]]

Ok thank you no problem.

[[Li...]]

JWD has revised the video in response to the feedback he received.  Here’s the new “Dear Colleague” video for prescribers about protracted withdrawal —  what it is, why it may occur, how to prevent it, and how to support patients who suffer from it.  (Cross-posted to Benzos in the News)