Valium; mirtazapine - safe taper methods

[[Ju...]]

 

Hello:

I am a 62-year-old female. I have been on a very long-term regimen of Valium. I began at age 31 at 5 mg for about 5 years, which then was upped to 10 mg. I stayed on this 10 mg dose for many years.  In 2021 there were some very personal issues that cropped up  -- an identity crisis that was exacerbated around the time of my retirement, the illness and death of my mother -- all at the age of 59.  My anxiety navigating the medical system during her care for the months before her death, along with other personal issues, caused me to increase my dose to around 22 mg, then 25 mg, then eventually 33 mg. I have been on a 33 mg dose for about 2.5 years. I am very concerned about my use of Valium.

I am also on the antidepressant sertraline (200 mg) and another antidepressant mirtazapine (60 mg). I was also prescribed pregabalin (300 mg) to help with alcohol withdrawal and to support the exogenous source of GABA.

I am reading stories about BIND (benzodiazepine-induced neurological dysfunction) and fear that some of the symptoms described apply to me. For example, I have developed tremendous hyperactivity and irritability at the slightest things that go wrong during my day. I am scratching myself and wringing my hands a lot. I snap at people. I have needed to get accommodations for a certificate study program I am in due to my mental health, something I have never needed in the past when doing my M. Ed. at the age of 50-53.

I am enrolled in a dialectical behavioural therapy program (DBT) because of a tentative diagnosis of borderline personality disorder/ traits by a psychiatrist in January 2024. I was also drinking heavily for 2 years (about 3 glasses of wine per day). I have stopped drinking (sober since mid-April 2024). Knock on wood.... the withdrawal from alcohol was relatively easy because of the Valium I am on. I do not know if the diagnosis of BPD was precipitated by my drinking and the combination of medications I am on.

Questions:

1)     When I began a taper (from 33 mg to 32 mg for 1 week) it became incredibly difficult (agitation, skin crawling, etc.). I went back up to 33 mg. Question: How to reduce / taper gradually? Any advice? Liquid micro-tapering? Ashton manual method? Are there some supplements that can assist with tapering? I have seen some online on YouTube channels (CBD oil – no THC; glutathione; theanine; inositol; Magnesium L-threonate)

2)     I am on a higher-than-recommended dose of mirtazapine (doctor’s approval). I take it 4 times per day (15 mg each time) – this dosing schedule helps with my anxiety throughout the day.  Question: What would you recommend for tapering off mirtazapine? I know I am not taking it as usually recommended (recommended is to take it before sleep). The websites I have visited recommend a 10-25% reduction that lasts 2 weeks at least – i.e., it should NOT be a rapid reduction.

3)     Question: Are there any other bits of advice you have for my situation? I do not want to cause myself harm by tapering too quickly from any of the above.

[[Pa...]]

Hello @[Ju...], welcome to BenzoBuddies,

First of all, I have to question being given a diagnosis of "borderline personality disorder/ traits" when what I'm seeing is symptoms of tolerance withdrawal from the Valium.  Your body is dependent on the medication and over the years, you've had to increase it to achieve the same effect.  The trouble is, symptoms will still break through even though you've increased the dose.  The hyperactivity, a very common symptom, the irritability and the skin issues are all symptoms so I wouldn't give too much credence to your tentative diagnosis.

I'm happy to see you've stopped drinking because benzodiazepines and alcohol affect the same receptors in the brain, in fact, alcohol has been called liquid benzo's so stopping that will aid you when you begin your taper.  

I wouldn't suggest tapering from the Mirtazapine until after you've gotten off of the Valium and recovered from your use.

We typically suggest reducing your dose by about 5-10% every few weeks or whenever your symptoms will allow, we hope to see members use their symptoms as a guide rather than rely on the calendar, this will hopefully keep us functioning.  Given you suffered making that small 1 mg reduction, I can see you're going to need to go very slowly.  Valium comes in liquid form for easy tapering but it also comes in 2 mg pills so many members dry cut their way to freedom.

Supplements are hit and miss, what may help one person will harm the next because our central nervous system is so sensitized. 

I'm sure I haven't answered all of your questions, but this will get us started.

@[Pa...]