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Restarting Taper after long hold


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[Ca...]

I don't know the answer to that question unfortunately, but I wanted to add that my Rite Aid in NY will dispense the liquid valium so I don't know if every Rite Aid would but who knows. I also agree that independent pharmacies are a better bet if they are comfortable doing it

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[Li...]

Greetings @[ro...].

Making a do-it-yourself liquid using regular diazepam tablets and homogenized, full fat milk has worked well for members here and in other communities over the years.

In terms of accuracy and precision of dose, my opinion is that using the manufacturer’s liquid or a professionally compounded liquid is preferable.  However, if you can’t obtain either of those, using milk to make your own liquid is definitely worth consideration.

Here’s what the recently published Maudsley Deprescribing Guidelines has say about using milk as an off-label option for patients who require smaller doses:

Benzodiazepines are more soluble in oil or fat than in water (Macheras et al 1990).  When mixed with full-fat homogenized milk, some or all of the drug will dissolve in the milk fat.  This should form an evenly dispersed emulsion when shaken vigorously …. As stability cannot be assured, the measured dose should be taken immediately and the remainder discarded.  (Horowitz & Taylor, 2024, p. 341)

Might I offer a clarification regarding the other ingredients (excipients) contained in diazepam tablets (as well as the tablets of other benzodiazepines)?

A common misconception is that “Excipients in regular tablets are just binders and fillers and do not matter.”  Although some excipients may indeed be functioning as binders and fillers, others may be facilitating the therapeutic functionality of the Active Pharmaceutical Ingredient (API).  For example, some excipients may affect the bioavailability and pharmacokinetic profile of the API.  Other excipients may help maintain the stability of the API over time by protecting it from degradation.   

PS  If you do end up making a do-it-yourself (DIY) with milk, I suggest using a combination of tablets and liquid as I outlined in a previous post for at least two reasons. First, you’ll keep as much of your dose as possible in a solid dosage form with known properties.  (To our knowledge, DIY liquids have not been professionally analyzed so we do not know their properties.)  Second, you’ll keep as much of your dose as possible in the dosage form to which your body is accustomed.

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[ro...]
2 hours ago, [[L...] said:

Greetings @[ro...].

Making a do-it-yourself liquid using regular diazepam tablets and homogenized, full fat milk has worked well for members here and in other communities over the years.

In terms of accuracy and precision of dose, my opinion is that using the manufacturer’s liquid or a professionally compounded liquid is preferable.  However, if you can’t obtain either of those, using milk to make your own liquid is definitely worth consideration.

Here’s what the recently published Maudsley Deprescribing Guidelines has say about using milk as an off-label option for patients who require smaller doses:

Benzodiazepines are more soluble in oil or fat than in water (Macheras et al 1990).  When mixed with full-fat homogenized milk, some or all of the drug will dissolve in the milk fat.  This should form an evenly dispersed emulsion when shaken vigorously …. As stability cannot be assured, the measured dose should be taken immediately and the remainder discarded.  (Horowitz & Taylor, 2024, p. 341)

Might I offer a clarification regarding the other ingredients (excipients) contained in diazepam tablets (as well as the tablets of other benzodiazepines)?

A common misconception is that “Excipients in regular tablets are just binders and fillers and do not matter.”  Although some excipients may indeed be functioning as binders and fillers, others may be facilitating the therapeutic functionality of the Active Pharmaceutical Ingredient (API).  For example, some excipients may affect the bioavailability and pharmacokinetic profile of the API.  Other excipients may help maintain the stability of the API over time by protecting it from degradation.   

PS  If you do end up making a do-it-yourself (DIY) with milk, I suggest using a combination of tablets and liquid as I outlined in a previous post for at least two reasons. First, you’ll keep as much of your dose as possible in a solid dosage form with known properties.  (To our knowledge, DIY liquids have not been professionally analyzed so we do not know their properties.)  Second, you’ll keep as much of your dose as possible in the dosage form to which your body is accustomed.

Thank You for the information. Doing pill milk solution would be my last choice. So the place I will have a Televisit with has the liquid diazepam solutions listed. my next option would be to have a compounded diazepam solution made from diazepam powder and oil. Last if none of these are available I would have to do a DIY milk diazepam solution. I copied and pasted the liquid solutions from the Harmony United Psychiatric portal. I want to thank you once again for taking the time to explain every taper method in detail. especially the milk taper. you have been so helpful as have other BB members who have chimed in

 also, they have listed  DIAZEPAM INTENSOL
I need to find out from Harmony United psychiatry about if there are pharmacies close to me that carry any of these solutions

 

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[Li...]

You’re welcome @[ro...].  I admire the calm, systematic, and determined manner in which you are approaching your taper.  It reminds me of the rule of “Big P, little e” — the more time you devote to careful planning of a project upfront, the easier the execution.

That’s encouraging the Harmony portal includes links to liquid forms of diazepam.  Excellent idea to ask if they can direct you to pharmacies near you that stock these formulations.   

I hope you will continue to keep us posted so we all can learn from your experience.  

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[ro...]

I need to learn how to cope with the awful physical symptoms I am having. That is I need to get comfortable about being uncomfortable. Distraction is helpful. I am trying to do what I had done over 10 years ago. That would be using a compounded diazepam solution. The physical symptoms and thinking about them just cause extreme anxiety

I thought it was so strange that I had almost had the same symptoms as I did when I was at 12.8 mg. The increase from 12.8 to 15 mg eliminated these symptoms until I hit tolerance W/D. These burning sensations won't stop. I hope someone was supportive of you when you were tapering. I will take it day by day until my appointment on June 11th. then I  hope that the doctor can provide a taper plan. In 2013 there was no Benzodiazepine Cooperative list

I don't know your history but I do appreciate all your time and effort in helping me. If there is any BB member In Florida let me know and I will reach out to them and share my experiences.   I need to help someone and not just think about myself. I did message that BB member in Fl and told her that I have 2 appointments set up and I gave her the list of Florida providers that may be able to help her. But you deserve all the credit. You gave me the Benzodiazepine Cooperative list

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[ro...]
Just now, [[r...] said:

I need to learn how to cope with the awful physical symptoms I am having. That is I need to get comfortable about being uncomfortable. Distraction is helpful. I am trying to do what I had done over 10 years ago. That would be using a compounded diazepam solution. The physical symptoms and thinking about them just cause extreme anxiety

I thought it was so strange that I had almost had the same symptoms as I did when I was at 12.8 mg. The increase from 12.8 to 15 mg eliminated these symptoms until I hit tolerance W/D. These burning sensations won't stop. I hope someone was supportive of you when you were tapering. I will take it day by day until my appointment on June 11th. then I  hope that the doctor can provide a taper plan. In 2013 there was no Benzodiazepine Cooperative list

I don't know your history but I do appreciate all your time and effort in helping me. If there is any BB member In Florida let me know and I will reach out to them and share my experiences.   I need to help someone and not just think about myself. I did message that BB member in Fl and told her that I have 2 appointments set up and I gave her the list of Florida providers that may be able to help her. But you deserve all the credit. You gave me the Benzodiazepine Cooperative list

This message was intended for Libertas

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[ro...]

Sorry, I am having a bad day. Must be benzo brain. Still learning how to use this forum

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[Li...]

@[ro...] You are doing just fine using the forum.  If you want to bring a post to the attention of a specific member, you can use the @mention feature.  I’ve included instructions below.

Assembling a toolkit of techniques you can use to cope with withdrawal is key.  Here’s an overview of techniques you might find helpful:

Coping Techniques A to Z | The Withdrawal Project

Learning how to get comfortable with being uncomfortable is also key.  You might find Jennifer Swantkowski’s YouTube channel helpful. Jennifer has experience as a clinical therapist and is currently tapering a benzodiazepine.

Members have shared many tips and tricks for dealing with physical symptoms over the years.  If you have a particularly vexing one, you can use our search engine to locate past posts.   Or, you can start a New Topic on this forum asking for input. 

How to use @mention

  1. Enter the @ in the body of your post.
  2. Enter the first several letters of the member’s username.  For example: @rob
  3. A pop-up menu will appear listing all members who have usernames beginning with those letters.
  4. Select the username of the member you wish to mention.
  5. The @ plus the username will appear in a blue oval. For example: @[ro...]
  6. If the member has notifications turned on, they will receive an alert and a link to your post.
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[Do...]
On 26/05/2024 at 18:36, [[r...] said:

Thank You to everyone who has responded to my post. I appreciate and welcome your suggestions.

I am feeling sick today. Another night of no sleep and awful symptoms again today. My anxiety has ramped up to the point where I just want to lay in bed and try to get some rest. I put on some sleep music from YouTube and am just lying down hoping that I will relax and the anxiety will go down. I may not post for a while. I have nausea and stomach pain. But I do appreciate everyone who has posted advice on how to proceed. I will consider everything. I am now going to try to calm down. I believe I have gone into a deep depression

I want to wish all of you a happy Memorial Day weekend.   Thanks again.  Rob

Hi Rob,

Before i was stuck in benzo WD i was suffering severe anxiety and panic atacks that i could overcome with the help of CBT and doing deep breathing and relaxating. Now i am suffering from WD symptoms but i found out that those breathing and relaxation skills still work for the rebound anxiety i get from WD and skills that worked for my anxiety disorder do help with most of WD symptoms as many of them are related to adrenaline rushes and the nerves dysregulation.

I recommend you to work on what you mentioned, keeping calm, using those skill that everyone always mention; acceptance, allowness and letting go of fears and panic. Believe me it works and its the only thing that keeps me sane and safe when i have bad waves.

I am curious about why you made such a big hold of so many years. Theoretically updoses wont work after very long time, it usually relieves when you make some kind of mistake, for example once i made a way too big cut and got very sick after 4 days so i updosed to the dose i was coming from and got better, after that i went micro taper and never felt that sick again.

 

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[Do...]
On 26/05/2024 at 19:10, [[C...] said:

At that point he would once again have to decide whether to taper off or increase the dose yet again.

As Winston Churchill said, when you are walking through hell, you keep walking...

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[Do...]
On 27/05/2024 at 05:28, [[r...] said:

As far as getting liquid valium from a pharmacist. I believe only a compounding pharmacy would have this and then the cost would be much higher than getting the pills. I pay only $2.50 for 90 pills of valium.

I taper from liquid diazepam not compounded, i buy manufacturer's from the brand and is as cheap as the pils are. The one i buy already comes diluted in ethanol.

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[Li...]
31 minutes ago, [[D...] said:

I taper from liquid diazepam not compounded, i buy manufacturer's from the brand and is as cheap as the pils are. The one i buy already comes diluted in ethanol.

 

Hello @[Do...]. Thanks so much for sharing that you are using a manufacturer’s oral diazepam solution and the cost is reasonable.  

If you are in the US and wouldn’t mind sharing … 

What is the concentration of your liquid? Is it 5mg/mL (25mg/5mL) or 1mg/mL (5mg/5mL)?  If it’s the 5mg/mL Intensol/concentrate, the alcohol is functioning as a solvent, not a diluting agent; it also contains two other solvents, a little water, a pH adjuster, and a colorant (in addition to the diazepam). 

 

 

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[Do...]
Posted (edited)
23 minutes ago, [[L...] said:

Hello @[Do...]. Thanks so much for sharing that you are using a manufacturer’s oral diazepam solution and the cost is reasonable.  

If you are in the US and wouldn’t mind sharing … 

What is the concentration of your liquid? Is it 5mg/mL (25mg/5mL) or 1mg/mL (5mg/5mL)?  If it’s the 5mg/mL Intensol/concentrate, the alcohol is functioning as a solvent, not a diluting agent; it also contains two other solvents, a little water, a pH adjuster, and a colorant (in addition to the diazepam). 

Hi @[Li...]

I am not in the US. I am in Europe (Spain) and my manufacturer’s oral diazepam solution is a concentrate of 2mg/1ml and also contains Ethyl alcohol Sucrose and others and the price is 2.93€ (3,18$) for 30ml bottle.

I use 1ml + 19ml of water and i get 20ml of water wich contains 2mg of diazepam and is very easy to make micro cuts, usually i taper 0.01 or 0.02mg daily by removing 0.1 or 0.2ml with a syringe.

PD. I having been able to find a benzo wise doctor in Spain, i only have my GP who is willing to prescribe the liquid but he doesnt help or support me in any other way. I dont even think he believes in my story (i told him i had to make a year log taper for 5mg of diazpeam and he told me i had a nice challenge to enjoy) but i had lorazepam prescribed for a long time so i think it doesnt make any difference for him.

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[Li...]

Thank you for the clarification @[Do...].  Given that @[ro...] has been looking at formulations for oral diazepam solutions in the US, I thought you might be US-based as well.  

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

Thank you for the clarification @[Do...].  Given that @[ro...] has been looking at formulations for oral diazepam solutions in the US, I thought you might be US-based as well.  

No i just wanted him to know that it was posible to buy what he said he was trying to compound himsef

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[ro...]
1 hour ago, [[D...] said:

Hi Rob,

Before i was stuck in benzo WD i was suffering severe anxiety and panic atacks that i could overcome with the help of CBT and doing deep breathing and relaxating. Now i am suffering from WD symptoms but i found out that those breathing and relaxation skills still work for the rebound anxiety i get from WD and skills that worked for my anxiety disorder do help with most of WD symptoms as many of them are related to adrenaline rushes and the nerves dysregulation.

I recommend you to work on what you mentioned, keeping calm, using those skill that everyone always mention; acceptance, allowness and letting go of fears and panic. Believe me it works and its the only thing that keeps me sane and safe when i have bad waves.

I am curious about why you made such a big hold of so many years. Theoretically updoses wont work after a very long time, it usually relieves when you make some kind of mistake, for example once I made a way too big cut and got very sick after 4 days so I updosed to the dose I was coming from and got better, after that I went micro taper and never felt that sick again.

I was a caretaker of my ex-wife back when I increased my diazepam dosage. She had really bad Multiple sclerosis. When I had to discontinue my dose of 12.8 mg, I had to go doctor shopping to prescribe diazepam.  As you probably know most doctors are ignorant of Benzo's dependence and W/D symptoms. I wanted him to prescribe me 2mg pills but he said it would be too many pills so He prescribed 5mg pills. Every symptom I had of burning sensations in my mouth, throat, and eyes disappeared. I still had Tinnitus which I had as an only symptom before the burning sensations. I was corresponding with another BB member and her Tinnitus was extreme. So she said I could probably stay on the same 15mg dose for life and would only have mild Tinnitus.

 

So I waited for months which turned into years. I was hesitant to try the tapering methods used on the BB forums. I thought I would try to get compounded diazepam from another doctor and try tapering again. I told him about Ashton and what she had written about W/D. He was insulted that he didn't believe him that there was no such thing as protracted W/D. He said he couldn't help me and that I should call Ashton So I left his office. No doctor I went to would prescribe me diazepam or listen to me when I asked if they could prescribe a compounded or liquid diazepam solution being a caretaker for my wife at the time was my priority. I could not see her suffer. So I just gave up on tapering expecting that I could remain on 15 mg of diazepam for life and only suffer mild Tinnitus which was acceptable. There was no benzodiazepine coalition provider list. This is when I thought I was stuck. The only Doctor that I had was in his 80s and he died. All I knew about tapering was with the Compounded Valium solution. Somewhere in the taper before I got to 12.8. I should have slowed down or held.

It is odd to me that for 10 years I had been symptom-free and now I have the same symptoms as I had back at 12.8mg. Everyone on the BB forums has different symptoms and the intensity varies. I am 69 and I don't even know if I were to taper, would my brain ever return to normal? neuroplasticity does not always happen when we age. I am very afraid I have permanent damage and may never recover. Will ask the doctors from the Benzodiazipine Coalition about this

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[ro...]

I need to go now my symptoms are really bad and I need to gargle with a mouthwash containing lidocaine and then drink ice water. My anxiety is ramping up. This happens whenever my symptoms become so intense.

Thanks for responding to my posts. I wish you well

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[ro...]

@[Do...] @[Li...] Good night and thanks for posting I am trying to learn to post to members of the BB forums using the @. I thought I was so brain-damaged that maybe I couldn't learn or focus anymore.

I am going to get ice cubes to try and numb the burning sensation and a washcloth with cold water to put over my eyes. Strange I don't notice the Tinnitus as bad right now. I rather have Tinnitus than these burning sensations 

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[Do...]
13 minutes ago, [[r...] said:

I was a caretaker of my ex-wife back when I increased my diazepam dosage. She had really bad Multiple sclerosis. When I had to discontinue my dose of 12.8 mg, I had to go doctor shopping to prescribe diazepam.  As you probably know most doctors are ignorant of Benzo's dependence and W/D symptoms. I wanted him to prescribe me 2mg pills but he said it would be too many pills so He prescribed 5mg pills. Every symptom I had of burning sensations in my mouth, throat, and eyes disappeared. I still had Tinnitus which I had as an only symptom before the burning sensations. I was corresponding with another BB member and her Tinnitus was extreme. So she said I could probably stay on the same 15mg dose for life and would only have mild Tinnitus.

So I waited for months which turned into years. I was hesitant to try the tapering methods used on the BB forums. I thought I would try to get compounded diazepam from another doctor and try tapering again. I told him about Ashton and what she had written about W/D. He was insulted that he didn't believe him that there was no such thing as protracted W/D. He said he couldn't help me and that I should call Ashton So I left his office. No doctor I went to would prescribe me diazepam or listen to me when I asked if they could prescribe a compounded or liquid diazepam solution being a caretaker for my wife at the time was my priority. I could not see her suffer. So I just gave up on tapering expecting that I could remain on 15 mg of diazepam for life and only suffer mild Tinnitus which was acceptable. There was no benzodiazepine coalition provider list. This is when I thought I was stuck. The only Doctor that I had was in his 80s and he died. All I knew about tapering was with the Compounded Valium solution. Somewhere in the taper before I got to 12.8. I should have slowed down or held.

It is odd to me that for 10 years I had been symptom-free and now I have the same symptoms as I had back at 12.8mg. Everyone on the BB forums has different symptoms and the intensity varies. I am 69 and I don't even know if I were to taper, would my brain ever return to normal? neuroplasticity does not always happen when we age. I am very afraid I have permanent damage and may never recover. Will ask the doctors from the Benzodiazipine Coalition about this

I understand. I am sorry you had to stay on the drug for a decade but i know your reasons and your wife was more important but i guess you didnt know about tolerance at that time. As @[Cr...] perfectly described, when you are not tapering you can get stuck in a hold/updose/hold/udose cycle for ever and i am so impresed and amazed you could stay on the same dose without reaching tolerance for a decade.

In every manual writen about benzo WD the first lines are that you should first think if you wanna taper and if you are willing to cope the nightmare but i guess once you decide to taper the best option is to go all the way.

Believe in neuroplasticity, you might heal slower or in a different way but you will heal, just make a good plan and follow your knowledge cause you seem to have a lot of it.

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[Li...]

Way to go @[ro...] - you have mastered the fine art of using the @mention feature.  If you begin to doubt your ability to focus and learn, just re-read your posts in this thread.  They provide ample evidence that you can!

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[ro...]
17 minutes ago, [[D...] said:

I understand. I am sorry you had to stay on the drug for a decade but i know your reasons and your wife was more important but i guess you didnt know about tolerance at that time. As @[Cr...] perfectly described, when you are not tapering you can get stuck in a hold/updose/hold/udose cycle for ever and i am so impresed and amazed you could stay on the same dose without reaching tolerance for a decade.

In every manual writen about benzo WD the first lines are that you should first think if you wanna taper and if you are willing to cope the nightmare but i guess once you decide to taper the best option is to go all the way.

Believe in neuroplasticity, you might heal slower or in a different way but you will heal, just make a good plan and follow your knowledge cause you seem to have a lot of it.

I was surprised that I was able to stay on the same dose for 10 years. Never went into Tolerance W/D

I thought well if I can go 10 years and never go into Tolerance. I have other health issues, Diabetes Chronic kidney disease, and Coronary artery disease with congestive heart failure Also I have a small aneurysm of my Aorta. My heart needs to be checked periodically. If the Aorta has a major aneurysm, I could die instantly. If my kidney goes into stage 1 I would need dialysis or possibly kidney transplant. So I am so careful to eat right.

No processed food. I cook everything from scratch and always include fresh vegetables and fruit. I can't believe how much weight I have lost I weigh 153 pounds and am 5'11. I was going to the gym daily lifting weights and walking on the treadmill, I sustained an injury and didn't exercise. This is when the Tolerance W/D surfaced. I mistook this as the cause of the Tolerance W/D,

I live in a house alone and maintain it, Today I cut the grass but stopped as it was too hot. When you have a house work never stops. I force myself to do all the work and maintenance

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[ro...]

@[Li...]@[Do...] Hey my friends I need to get these symptoms down. So I will leave this conversation Thank you both for posting and for all the advice and knowledge I have gained from both of you.

 I am looking forward to my Televisits from the 2 psychiatrists. I hope to gain information about tapering and coping mechanisms so I can work through the awful symptoms I need to keep this house up and prepare for the hurricane season which began on June 1st

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[ro...]

@[Li...] @[Do...] @[Cr...] Hello BB members you have all posted on my Topic. I wanted to share with you some things I have found on the Internet about Benzodiazepines. Finally, a Netflix documentary has examined the Benzo Xanax. It covers people's experience of withdrawal. The title is called 

 

 

Take Your Pills: Xanax.   At the minute mark 57, a man named John shows how he does a daily microtaper of Xanax, He has all the equipment of a chemistry lab in his house and is demonstrating how he makes minuscule cuts daily of Xanax, He says it will take years but he will be pretty much symptom-free.

Another video I found on youtube is about a Harvard-educated Otoneurologist. His name is Dr. Robert Aaron Levine. his video is about Tinnitus and he explains how benzodiazepines can quiet Tinnitus. He also has a website showing his studies have shown how different benzos can eliminate Tinnitus. In the youtube video, he goes into great detail about exactly where Tinnitus takes place in the brain and the role of Benzos in stopping it. I love science and I love physiology. So I wanted to share this information.

Youtube video from Dr Levine is  

 

 

There is more from Dr Levine A website where he has used Benzos to quiet Tinnitus. I couldn't find his website Looks like it was removed. on his website, he explained what dosage he used to quiet Tinnitus he never mentions long-term dependence and W/D. He had his website explaining his research and credentials I just can't find it anymore. The YouTube video remains. He used a small control group of people suffering from Tinnitus and then he had them take a benzodiazepine, He said 75% of patients had the Tinnitus eliminated or quieted. He was Teaching at a hospital near Harvard

 

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[Cr...]
Posted (edited)

Awesome @[ro...]

As you can see you are never too old to learn. Like @[Li...] said, you have gotten the handle on how to use the features of this forum rather quickly. Also posting youtube links to boot. I'd say your brain is ripe for learning and repairing itself.

Thank you for sharing that info as I am sure there are lots of members that may find comfort the more they educate themselves.

It seems like the increasing availabilty of the internet and smart phones around the world has helped to bring the realities of benzo withdrawals from the fringes to a greater population of people. Enough so as to now get many documentaries as well as highlights in the news.

I will check it out.

Edited by [Cr...]
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[ro...]

@[Cr...] @[Li...] @[Do...]. I made a mistake in posting about Dr Levine's YouTube video. I just wanted to show how doctors even the best highly educated and qualified make Mistakes. He never knew about the long-term use of benzos and the dependence that comes with it. The Netflix documentary discusses Benzo addiction and dependence. It also has a segment with Dr Heather Ashton speaking about benzodiazepines.

Before the 7-minute mark, John is showing his microtaper. Before this John explains how he had all these awful symptoms and he and his wife went from Doctor to Doctor and had all these tests done they found nothing wrong. So he came on the Ashton manual and he saw every symptom he had was from diazepam withdrawal

That is when he started his microtaper. He said the chemistry courses he had helped him to be able to accomplish this, This Netflix documentary is informative. I hope all doctors who prescribe Benzos will watch this film. They would then see that long-term use creates dependence and withdrawal symptoms. The withdrawal symptoms could be Tolerance W/D or could be from people who Cold Turkey or attempt to taper off too fast. The Otoneurolgist was trying to help his patients with Tinnitus. The big mistake he made was suggesting that people could take it forever. He never researched the long-term effects had he done this and come upon Dr Heather Ashton's manual, he would never have put people on Benzos. His website is down, I think finally enough people have bad W/D symptoms that word has spread. 

I hope someday doctors realize the dangers of long-term benzo use. Then they will see how dangerous they can be, They will also understand about how necessary it is to taper off a Benzo slowly and will help their patients. I saw the film's title while looking at content on Netflix. I had to watch this and for me, my story is similar to John's, I have been on a daily dose of 15mg diazepam for 10 years. I just recently got Tolerance W/D

 

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