Hyperbolic Taper - Timeline

[[Fa...]]

I have just gotten down to .5mg of Clonazepam from 1.5mg.  When I work out how long it will take me to finish this taper based on the cut I can handle and the duration between cuts, it works out to 5 years to reach the recommended jump at .025mg.  Seem a little extreme?

To date, after experimenting with percentage and time between cuts, in order to remain as functional as possible, I can cut 3% every three weeks.  That is what my calculations are based on.

I just can't imagine this timeline.  I just hope that as I go lower I will improve and be able to handle larger cuts.

Would love to hear any feedback regarding this.

Thanks for your ear.

Warmly,

F

  

[[Al...]]

@[Fa...] It does seem extreme. Are the calculations for a hyperbolic taper all the way down to .025mg? If so, that would explain why it will take 5 years. At some point you will need to go linear. The following post is an example of going linear once you reach .125 mg. I hope this helps!

https://benzobuddies.org/topic/265829-how-i-tapered-the-end/

[[Fa...]]

@[Al...]  Thanks for your reply.  Yes...based on going all the way down to .025mg.  I've not read the Maudsley Guidelines, but I'm pretty sure it does not include switching to linear at some point.  If I'm wrong, please correct me.  However, I think the methodology is exactly that in much contrast to Ashton.

It makes far more sense to me to switch to linear at some point.  Otherwise, I'll have this drug in my body far too long which does not sit right with me.

Thank you!  I just needed to get this out of my head and on to the page for some feedback.

[[Al...]]

 

13 minutes ago, [[F...] said:

@[Al...]  Thanks for your reply.  Yes...based on going all the way down to .025mg.  I've not read the Maudsley Guidelines, but I'm pretty sure it does not include switching to linear at some point.  If I'm wrong, please correct me.  However, I think the methodology is exactly that in much contrast to Ashton.

It makes far more sense to me to switch to linear at some point.  Otherwise, I'll have this drug in my body far too long which does not sit right with me.

Thank you!  I just needed to get this out of my head and on to the page for some feedback.

For reference, the Maudsley deprescribing guidelines for a medium paced taper recommend the following reductions every 1 to 4 weeks. It's essentially a hyperbolic taper composed of linear tapers for each dose range. As the dose range lowers, the reductions get smaller.

4 - 2 mg...0.25 mg reductions

2 - 1.25 mg..0.125 mg reductions

1.25 - 1.05 mg...0.1 mg reductions

1.05 -0.4 mg...0.05 mg reductions

0.4 - 0.2 mg...0.04 mg reductions

0.2 - 0 mg...0.02 mg reductions

“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.” 

 

[[Fa...]]

Thank you for this.  I really appreciate it.  I did not realize it was a combination of hyperbolic and linear.  I will still have to work within I can handle, of course...but, at least I now know it will be linear at a certain point.  

[[Al...]]

No problem! Are you micro-tapering or cutting and holding? I'm still trying to figure out what is best for me.

[[Fa...]]

I am water tapering, but instead of daily micro tapering, I'm using the cut and hold.  So, I draw out the entire cut at once and hold.  It works well for me.

I read your history.  I'm sorry you have suffered Akathisia, too.  It's horrible.

[[Al...]]

13 minutes ago, [[F...] said:

I am water tapering, but instead of daily micro tapering, I'm using the cut and hold.  So, I draw out the entire cut at once and hold.  It works well for me.

How does the water tapering work? I've heard it mentioned but have no idea how it works in practice. Are you using a liquid or tablet to make the solution.

13 minutes ago, [[F...] said:

I read your history.  I'm sorry you have suffered Akathisia, too.  It's horrible.

Yes, there are no words to describe how horrible it is.

[[Pa...]]

5 minutes ago, [[A...] said:

How does the water tapering work? I've heard it mentioned but have no idea how it works in practice.

Here is a video for tapering Clonazepam, he uses whole milk. 

Bing Videos

[[Fa...]]

I can be wordy...so, bear with me.

My Clonazepam dissolves immediately.  There is no coating on whatever brand my pharmacy uses.  Using water is easy...much easier than shaving and weighing.  No liquid compounding necessary.  It is very easy to figure out.  And, my brain is fried much of the time.  Also a right brainer...so, mathematics is not my strong suit.  I am in Canada.  The generic brands I've heard others reference is not what I am on.  I know others have talked about their pills having a coating that makes them more difficult to dissolve...but, still do-able.

PRN...it was what slayed me.  It is what made me have to start my taper at 1.5mg...it's also what created the state I was in pre-taper.  It's what caused me to be placed on an AP which caused my AKA.  We have similar experiences.

 

Edited July 12 by [Fa...]

[[Al...]]

5 minutes ago, [[F...] said:

PRN...it was what slayed me.  It is what made me have to start my taper at 1.5mg...it's also what created the state I was in pre-taper.  It's what caused me to be placed on an AP which caused my AKA.  We have similar experiences.

Yes, PRN is a slippery slope. I'm so sorry for what you've been through. Is the AKA gone now? 

[[Fa...]]

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

Yes, PRN is a slippery slope. I'm so sorry for what you've been through. Is the AKA gone now? 

No, it is not gone.  But, it has subsided considerably.  I believe the further out I get from coming off the AP, the better off I have been.  I was pacing up to 16hrs a day for 14 months.  The mental aspect was horrific.  I sense you have been through the same by what I read.  How are you doing...has it subsided at all?  

[[Al...]]

Yeah, so what happened with me is that I got AKA and insomnia from raising my Prozac dose. I was then prescribed the benzo to treat the AKA and insomnia. It has taken the edge off, but in hindsight, I wish I had just toughed it out because being dependent on the benzo isn't worth it.

It is also complicating my taper, because I don't know what is going to happen when I lower the benzo dose. I have tried tapering below 0.5 mg a couple of times and my symptoms start ramping up. I've also had to lower my Prozac dose from 30 to 20 mg to try and calm things down. This is a nightmare on so many levels and there are days where it's hard to see a way out.

I can't believe you were pacing for so long. I honestly don't think I could have survived that. I've had AKA twice now. The first time, it lasted 9 months, but wasn't constant. This time, I couldn't face going through it again, so I took the benzo to get some relief. As mentioned earlier, I really regret that now, but it's not easy making decisions when you are in a state of panic.

[[Fa...]]

We all have regret through this.  Would have, should have, could have.  We all make the best choices given what information we have...but, in this, we make decisions when we are in a state of crisis and suffering.  I did the same with the AP.  So classic for a physician to offer another drug to cover up symptoms from a dose or medication gone wrong.  Now, we start correcting 'cause we have more insight and knowledge.  It can be done.  There is always a way out...period.

I have a better grasp on what has happened.  I remember I replied to your post regarding Clonazepam dosing.

This is my understanding.  Your situation is much like mine.  When you tried to reduce your Clonazepam, it wasn't necessarily that you were experiencing interdose WD or even reducing too much.  It is much more likely that it's due to your NS already going through the complications from your AD.  Reductions were just one push too many at this time.  It is best to handle one medication obstacle at a time.

How is your AKA now?  Are you now on the original dose of Prozac you were on prior to the increase?

Do not feel hopeless.  There is always a way through.

  

Edited July 12 by [Fa...]

[[Al...]]

The AKA is not completely gone, but it is much better. I'm just not sure how tapering the C will affect it. 

I'm not on the original dose of Prozac prior to the increase. That dose was 28 mg and I'm still on 20 mg. All the problems started when I tried to increase from 28 to 30. I was being really careful increasing the dose very gradually, but I wasn't careful enough. My problem is that I have OCD and 20 mg is a pretty low dose for that.

[[Al...]]

There were times when I took more than 0.5 mg PRN, so I think that may be an issue. I don't even know if 0.5 is the best starting point for the taper to be honest. If it is, maybe I need to stabilize on it longer before starting a taper? 

Also, I'm not sure which is best, cut and hold or DMT?

May I ask why you opted for cut and hold?

[[Fa...]]

I'm not sure what others have offered you in terms of what to do moving forward...options.  I do feel that you would benefit greatly from resolving the AD situation first.  I did read that you felt that it was no longer helping you as it was.  Before you begin your benzo taper, would you feel better to get the AD sorted?  Would that make you feel more comfortable?  Moving into a taper of the benzo, if at all possible, should start from as stable a position as possible.  And, that means having that feeling of safety before you move into WD.

Also, I was afraid of the ramifications of tapering with the AKA.  It was a very real fear of mine.  I started very slowly.  I was in full blown AKA when I began tapering again.  It can be done.  It's not ideal.  But, none of this is ideal.

[[Fa...]]

When I look back now, I see that the problem was not that I was daily micro tapering...it was that my NS was too sensitized...I was very unstable.  I believed that DLMT was not working for me.  But, that wasn't it at all.  For all intents and purposes, I CT'd an AP.  I didn't even think about that because I did not know better then.  So, I was dealing with terrible WD already.  And, I began to taper the benzo in that state.  When I started to taper again, I decided to do cut and hold because I felt as though I could anticipate what to expect better.  It was out of fear I chose cut and hold.  One thing people don't talk about with DLMT is that you still have to hold.  The body needs to process the cuts regardless of their being small cuts daily.  They build up, and you can find yourself in a place of hurting and having to hold for long periods if you don't place holds in your schedule.  At the end of the day, each person has to try things and find what works best for them.  Some really like DLMT...or DMT.  Some say it doesn't work well for them.  Trial and error.

 

[[Ca...]]

What is DMT

[[Fa...]]

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

What is DMT

Daily Micro Taper

[[Al...]]

12 minutes ago, [[F...] said:

I'm not sure what others have offered you in terms of what to do moving forward...options.  I do feel that you would benefit greatly from resolving the AD situation first.  I did read that you felt that it was no longer helping you as it was.  Before you begin your benzo taper, would you feel better to get the AD sorted?  Would that make you feel more comfortable?  Moving into a taper of the benzo, if at all possible, should start from as stable a position as possible.  And, that means having that feeling of safety before you move into WD.

Also, I was afraid of the ramifications of tapering with the AKA.  It was a very real fear of mine.  I started very slowly.  I was in full blown AKA when I began tapering again.  It can be done.  It's not ideal.  But, none of this is ideal.

I don't know what to do about the AD situation. The first time I got AKA in 2017, it was caused by trying to switch to Lexapro and then having to go back on Prozac at a higher dose. The moderators at Surviving Antidepressants told me that stopping the Prozac probably caused it (it was a 2 week taper). That's why I'm scared to make any changes to my AD now. I've been on Prozac a long time so I know that stopping it and trying to switch to another AD will be risky and raising the dose will be risky. That being said, 20 mg isn't enough to keep my OCD in check so I really don't know what to do.

[[Fa...]]

You will come to a decision.  Things will become clear as to what you feel most comfortable with.  You have a lot of information now.  You just have to sit with it, process it...and, you'll feel drawn to your next step.  Once you make the first decision, the rest will follow.  You're feeling stuck right now...but, you'll get unstuck.  And, there are so many here on the site that will be here to help you move forward with your decisions.  One medication obstacle at a time.

[[Fa...]]

36 minutes ago, [[A...] said:

There were times when I took more than 0.5 mg PRN, so I think that may be an issue. I don't even know if 0.5 is the best starting point for the taper to be honest. If it is, maybe I need to stabilize on it longer before starting a taper? 

Stabilizing is a subjective term.  So, expectations regarding stabilizing need to be flexible.  Stabilizing doesn't mean feeling 100%...it's kind of knowing that what you are experiencing is the best it will be so you can move forward from that point.  It's like a gut feeling that you're in as good a position as possible to move forward.

[[Al...]]

Thanks for the advice and taking the time to discuss things with me.

Can I ask one more question?

When you make a cut, how long does it take for you to feel the effects?

[[Fa...]]

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

Thanks for the advice and taking the time to discuss things with me.

Can I ask one more question?

When you make a cut, how long does it take for you to feel the effects?

I'm all over the board.  Sometimes I feel it immediately, sometimes I can start to feel it on day 3, day 5.  Sometimes I don't notice a change until day 10 and I don't 'recover' until just before my next cut.  Many have a pattern, I don't.  Even though my goal in cut and hold was to have more foresight...I never did get it really.  Most people on Clonazepam say they feel it between day 3-5 and it starts to level off again by day 10.  I'm not a great example of what to expect.

You're very welcome.  It's the most dialogue I've had in a long time.  Thank you for helping me, also.  It's taken some heaviness off of me.