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Last 1 mg Valium microtaper based on Horowitz hyperbolic theory and steepest part of curve


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[re...]

What are your opinions and take on the steepest part of the receptor curve.

Yes I understand this is a THEORY only. So please it is already noted.  I get this point already.  But is there any info on say a difference in the 2-1mg step down vs the 1-.5 or even 0 with regards to this curve? 

I am not trying to overthink this even though it sounds like I am. Well maybe a little. :2funny:  But I really do have a more in depth questioning as it fascinates me on a bigger level than just myself.  And if I get through this I think I will spend my life trying to get this through to a bigger awareness. Just think of how many people are listening to their doctors with DISASTOUROUS results and not getting any better and still on enough drugs to choke a horse when maybe their brain is ready for this receptor occupancy type method of medicine removal. 

 

I want to hear experiences with your last bit of benzo. I don't care what benzo. My curiosity is how was it coming down from say your last 1 mg Valium or .05 K or whatever you were on?

I just wanna take this thing all the way down to the .30 jumping point Horowitz recommends. 

Try and understand that I am in complete agreeance with the Whole Ashton protocol which is very similar to what Horowitz has observed, but let's be honest she is not with us anymore and he is alive with passion actively getting this info out to many. As well as taking the criticism/skepticism and the arrows while the majority stay silent in the higher positions in the scientific/medical/psychiatry community. And he WAS harmed by SSRI's himself so i can't help but think he has lots of experience on BOTH sides. He is the new vocal representative for tapering and I am sure he is getting pushback cause he is a bit more aggressive and making the rounds. It is sad that I only really see such a small amount of professional people being vocal on you tube and this 2024 for gods sakes. This should be much more popular at this time and it still isn't.  

Think about this. How many of you have given the Ashton Manual to your doctor only to be frustrated on the complete arrogance of your doctor's inability to validate this crucial literature. We need someone in the MODERN age to be "going to bat" so to speak for us lonely souls and Mr. Horowitz seems to be doing this in flying colors with passion yet well spoken demeanor. 

 

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[re...]

 

Just try and understand when I first got harmed with a  big (10 in total) cocktail of meds from head meds to regular meds due to a serious hyponatremia (low blood salt from working in 114 degree weather) event where I went into an extended status epilepticus thanks to their delayed care and misjudgment of my condition and became comatose and incurred a $100k ICU stay.

I developed SERIOUS post ICU stay CNS problems that not a ONE freaking SOB doctor believed me or held the nuclear bomb of meds I was given in ICU accountable. I am talking all high dose IV stuff here. Not just some pills.  

So I started to delve deep in MANY forums not just Psych med stuff like BB or Surviving Antidepressants. But also epileptic forums and the like and even THESE so called Professional Epilepsy doctors and neuros are really taking their patients off of Lamictal, Keppra, Depakote, etc  WAY WAY fast. You have no idea. So of course the patient goes all ape and has way more seizures then they call it................ you guessed it................  a RELAPSE.

Just like the psych docs with their barbaric taper schedules.  So this is an epidemic of HUGE proportions being perpetuated on many many people. Not just the usual psych patients. I WANT JUSTICE DAMNIT!!!!!!!!!!!!!!!! Too many people are getting harmed. 

So can this Hyperbolic curve apply to ALL drugs like even AED'S?  These are WAY more heavy than benzos believe me. They seem to work on many more receptors than just Gaba receptors. And these people have Ativan and Diazepam "emergency" doses which seem to correlate with more seizure activity when they wear off. Imagine that. Or even others like PPI's, Beta blockers, etc. Most drugs are delivered via receptor systems in us so that is why I question all of this stuff of hyperbolic tapering. 

There is one girl Angelique Busko with a you tube channel "My journey to be seizure free" who got seriously harmed from vaccines (hmm who would of thought) and it led to an epileptic condition that talks about this very thing. 

 

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[Do...]
8 hours ago, [[r...] said:

Try and understand that I am in complete agreeance with the Whole Ashton protocol which is very similar to what Horowitz has observed, but let's be honest she is not with us anymore

I think the Ashton manual is a master piece but uncompleted. It has lots of "script holes" like the low dosing tapering and such other stuff that they havent even consider.

Yes is so sad that 99% of doctors, includint psychiatrists havent even heard od Ashotn or Horrowitz's work.

But for me is crystal clear that no one raises their voice on this cause they are cowards and they will be "on board" this "boat" when it becomes trendy, not doubt about it.

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[Do...]
2 hours ago, [[r...] said:

So this is an epidemic of HUGE proportions being perpetuated on many many people.

I am a spaniard and in my country, last week, they talked about this in the news something like "the goverment is gonna study this problem". And you will understand how serious and lame this is when you realize that Spain is top 3 countries in the world prescribing benzos legally and yet they have done nothing so far.

This is form an academic study: "The highest prevalence of BZD use was identified in Croatia (35.5%), Spain (33.5%) and Serbia (31.3%)."

I dont have a psychiatrists right now cause the one i had was the one who brought me here but i havent stoped lokking for one that can help me with this hell. Yerterday i called one somewhere at the other end of Spain that was in the internet as "specialist in benzos" and when i talked to him he said that he knows how to taper of course, like any other psychiatrist do, "just cut 50% of the dose every week and just in 3 or 4 weeks".

https://compartir.coop/en/health/spain-leads-world-consumption-benzodiazepines

 

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[Li...]
3 hours ago, [[r...] said:

But is there any info on say a difference in the 2-1mg step down vs the 1-.5 or even 0 with regards to this curve? 

 

Per the taper regimens for diazepam presented on pages 407-410 in The Maudsley Deprescribing Guidelines (Horowitz & Taylor, 2024):

At a TDD of 2mg, RO is 7.5%
At a TDD of 1mg, RO is 3.9%.
At a TDD of 0.5mg, RO is 2%.  
At a TDD of 0.4mg, RO is 1.6%
At a TDD of 0.2mg, RO is 0.8%

Where TDD = Total Daily Dose and RO = GABA Receptor Occupancy

Two points to keep in mind: (1) benzodiazepines affect multiple receptors/neurotransmitters, not just GABA and (2) each of us is unique (e.g. different people can have very different reactions to the same medication).

To me, one of the most important lessons to be learned from The Maudsley Deprescribing Guidelines is:

“Ultimately, it is the patient’s experience of withdrawal that should guide the taper.” (p. 390)

 

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[Do...]
3 minutes ago, [[L...] said:

At a TDD of 2mg, RO is 7.5%
At a TDD of 1mg, RO is 3.9%.
At a TDD of 0.5mg, RO is 2%.  
At a TDD of 0.4mg, RO is 1.6%
At a TDD of 0.2mg, RO is 0.8%

Hi Libertas,

Not sure is i understand what this means; at, for example, 2mg receptor occupacy is 7.5%. Occupacy by the benzos? what about the other 92.5%? is not occupied at all? is it partially or totally occupied by brain gaba?

thanks for sharing this.

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[re...]

Oh I LOVE this. Thank you thank you Libertas. Major props here. :clap:

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[WU...]
12 minutes ago, [[L...] said:

At a TDD of 2mg, RO is 7.5%
At a TDD of 1mg, RO is 3.9%.
At a TDD of 0.5mg, RO is 2%.  
At a TDD of 0.4mg, RO is 1.6%
At a TDD of 0.2mg, RO is 0.8%

Curious to know how they calculate these figures. Does Horowitz et al. explain this in the guidelines?

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[re...]

It's just nice to have some numbers and of course always go by your own symptoms and tolerability. 

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[Ma...]
5 minutes ago, [[L...] said:

At a TDD of 2mg, RO is 7.5%
At a TDD of 1mg, RO is 3.9%.
At a TDD of 0.5mg, RO is 2%.  
At a TDD of 0.4mg, RO is 1.6%
At a TDD of 0.2mg, RO is 0.8%

 

I think this is very interesting data, but how to apply it practically is something we are far from right now.  I’m not sure what kind of studies the data were based on because I haven’t read Maudsley, but in at least one of his talks it was based on rat brain studies.  Again, not discounting his theories about hyperbolic tapering because I think there is evidence to support it, but I think people need to be really careful trying to apply these data to something practical like a benzo taper without actual clinical data.  As always, the best taper is the one that someone tolerates well. It’s extremely individualized.  


When we do a steroid taper, just as a comparison, the taper schedule is based on loads of data on how our adrenal glands recover from exogenous corticosteroid administration.  We know exactly how long and what doses to taper to based on decades of clinical and lab data and outcomes, not just a couple studies of lab data.   

In the future, it would be most useful for Dr. Horowitz or others in the field to study large groups of people tapering off at different rates and doses.  I’m a physician but not a researcher so I’m not sure how practically possible that is, but that will be what gives the best answer to OP’s question.  

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[Li...]
17 minutes ago, [[W...] said:

Curious to know how they calculate these figures. Does Horowitz et al. explain this in the guidelines?

 

Yes.

“Neuroimaging data for diazepam were used to derive a receptor occupancy curve.  The receptor occupancy curves for other benzodiazepines and z-drugs were derived from this relationship using equivalency tables. Pharmacologically rational regimens were then calculated from these equations and are presented as ‘faster’, ‘moderate’ and ‘slower’ regimens.” (Horowtiz & Taylor, 2024,p. 362)

 

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[Li...]
49 minutes ago, [[M...] said:

I’m not sure what kind of studies the data were based on because I haven’t read Maudsley, but in at least one of his talks it was based on rat brain studies.

“Neuroimaging data for diazepam were used to derive a receptor occupancy curve.  The receptor occupancy curves for other benzodiazepines and z-drugs were derived from this relationship using equivalency tables. Pharmacologically rational regimens were then calculated from these equations and are presented as ‘faster’, ‘moderate’ and ‘slower’ regimens.” (Horowtiz & Taylor, 2024, p. 362)

49 minutes ago, [[M...] said:

I think people need to be really careful trying to apply these data to something practical like a benzo taper without actual clinical data.  As always, the best taper is the one that someone tolerates well. It’s extremely individualized.

I agree and suspect Drs. Horowitz and Taylor would as well.  This paragraph is repeated for each of the benzodiazepines and z-drugs addressed:

“Please note that none of these regimens should be seen as prescriptive — that is, patients should not be compelled to adhere strictly to them.  They are given as example regimens and are not ‘set and forget’ but should be modified in order to ensure that the withdrawal symptoms are tolerable throughout a taper …. Ultimately, it is the patient’s experience of withdrawal that should guide the rate of taper.” 

49 minutes ago, [[M...] said:

In the future, it would be most useful for Dr. Horowitz or others in the field to study large groups of people tapering off at different rates and doses.

Yes, it would.

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[Li...]
2 hours ago, [[D...] said:

Not sure is i understand what this means; at, for example, 2mg receptor occupacy is 7.5%. Occupacy by the benzos?

Yes.  

Receptor occupancy refers to the percent of GABA-A receptors occupied by the benzodiazepine.  

Per Horowitz and Taylor (2024):

“The relationship between dose of benzodiazepines and their effect on their principal target, the GABA-A receptor, is hyperbolic owing to the law of mass action. The law of mass action dictates that when few molecules of a drug are present, most receptors are unoccupied and so even small increases in the mass of drug present at the site of action produces large effects.  When there is more drug in the system, receptors are increasingly saturated, leading to diminishing returns in effect on target receptors for increases in the mass of drug added.” ( p. 332)

 

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[Ca...]

I have a question for Libertas......or anyone who knows...has anyone known of anyone doing a liquid microtaper of valium?

Also, has anyone heard of Dr. Josef Witt-Doering's taper clinic and know whether his group has had any better luck helping people avoid protracted withdrawal? I know that BIC's new medical director works with him, or did.

Thanks so much for any and all feedback!

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[Li...]
9 hours ago, [[C...] said:

I have a question for Libertas......or anyone who knows...has anyone known of anyone doing a liquid microtaper of valium?

@[Ca...] Yes. We have members who have used a liquid to microtaper Valium/diazepam.  If you wish to discover if we have currently active members who have used/are using this approach, might I suggest you Start a New Topic on our Benzodiazepine Withdrawal, Use & Recovery forum?  Enter your question in the Title box (e.g. “Who has experience liquid microtapering Valium?”).  You could also try using our search engine to look for past posts on this topic.

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