The cuts have caught up with me right before my jump dose

[[Ma...]]

Title says it all.  I’ve tapered down to a little less than .05 of Clonazepam over the last 16 months.  It’s been awful but I was seeing the light at the end of the tunnel, at least as far as this taper goes.  I’ve had a bad day here and there but it’s been mostly uneventful since a long hold at 0.5, u til these last 2 days: severe insomnia, head fullness, anxiety/panic feelings, tinnitus, etc.  I’ve really felt about 70-80% lately so I know I shouldn’t complain but I really cannot believe this is happening now.  You can see my taper history which is I believe on the moderate side as far as pace, but maybe I went a little too fast.  What’s done is done. This is the worst I’ve felt since my initial too big 25% cut.  I suppose I should just hold for another week or two but at some point soon this needs to end.  I’ve warned others to finish their tapers when they get to this stage and now it’s happening to me and I’m having trouble deciding what to do.  I had been planning to just do a liquid taper down to zero over the course of 14 days but now I’m not sure what to do.  Appreciate anyone’s opinions.  

Edited November 23 by [Ma...]

[[pi...]]

@[Ma...],

You have really done a good job with your taper. What you are describing sounds like how I felt during acute withdrawal. Could it maybe happening to you since you are not on a therapeutic dose? Honestly, I don’t know. 

You could go ahead and taper to zero but it’s hard to say if it would alleviate the symptoms you are experiencing. 

I try not to give taper advice since mine was certainly not textbook and was very rough. I wish you the best with whatever you choose to do. 

[[Ro...]]

3 hours ago, [[M...] said:

Title says it all.  I’ve tapered down to a little less than .05 of Clonazepam over the last 16 months.  It’s been awful but I was seeing the light at the end of the tunnel, at least as far as this taper goes.  I’ve had a bad day here and there but it’s been mostly uneventful since a long hold at 0.5, u til these last 2 days: severe insomnia, head fullness, anxiety/panic feelings, tinnitus, etc.  I’ve really felt about 70-80% lately so I know I shouldn’t complain but I really cannot believe this is happening now.  You can see my taper history which is I believe on the moderate side as far as pace, but maybe I went a little too fast.  What’s done is done. This is the worst I’ve felt since my initial too big 25% cut.  I suppose I should just hold for another week or two but at some point soon this needs to end.  I’ve warned others to finish their tapers when they get to this stage and now it’s happening to me and I’m having trouble deciding what to do.  I had been planning to just do a liquid taper down to zero over the course of 14 days but now I’m not sure what to do.  Appreciate anyone’s opinions.  

Looked at your History, and I can tell you did weekly reductions.  I'd suggest holding 2 more weeks at this dose.  I never felt comfortable with the idea of switching from tablet to liquid, but that's just me.

Yeah, you're probably basically in acute now with your benzo providing no real benefit.

Good luck.

[[Tr...]]

Hi @[Ma...], my heart goes out to you! I agree with @[Ro...] to hold for 2 weeks. I hope and pray that the sxs will subside and you can go down to 0.025 mg and jump off uneventfully!  🙏❤️🍀

Edited November 24 by [Tr...]

[[Ma...]]

38 minutes ago, [[R...] said:

Yeah, you're probably basically in acute now with your benzo providing no real benefit.

I guess I thought of acute as what this whole process was.  I thought by stepping down slowly and then off many people felt like it was “just another cut” when they eventually jumped off, which is what I’m still hoping for as it’s only been two days.  But maybe the terminology is just used loosely? 

[[je...]]

@[Ma...],  you’ve worked so hard to get here. I’m sorry you are struggling. It took me more than 2 months to go from 0.100 to 0.050 and you went from  0.09 to 0.045 in about 20 days. I’m only saying this to give you a comparison. It seems as if the symptoms are caused by a rushed taper.  Are you functional? What options are you considering? 

[[Ma...]]

6 minutes ago, [[j...] said:

 Are you functional? What options are you considering? 

Thanks for your response @[je...].  I have been mostly functional during the last part of the taper.  A few bad nights of sleep that lasted a day or two, and a little bit of anxious feelings here and there, but I’ve been able to go to the gym most days, go shopping, volunteer (I’m retired), hang out with friends most of the time, etc.  Friday hit me like a ton of bricks which I was a little shocked by.  I agree, my taper was faster but I was basing it on how my symptoms were and they were “ok” overall. Regardless, what’s done is done and I am where I am 😑.  Definitely not going to updose.  Considering just holding for a couple weeks and then doing a little water taper down to zero from .045 to 0 over a couple weeks.  But honestly, even if I don’t stabilize, do I even have many other options?  I’m VERY close or maybe at my jump dose.  TIA.

[[No...]]

I saw your history and just share @[je...]'s thoughts about rushed taper at the end. Probably holding will resolve that. 

[[je...]]

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

Thanks for your response @[je...].  I have been mostly functional during the last part of the taper.  A few bad nights of sleep that lasted a day or two, and a little bit of anxious feelings here and there, but I’ve been able to go to the gym most days, go shopping, volunteer (I’m retired), hang out with friends most of the time, etc.  Friday hit me like a ton of bricks which I was a little shocked by.  I agree, my taper was faster but I was basing it on how my symptoms were and they were “ok” overall. Regardless, what’s done is done and I am where I am 😑.  Definitely not going to updose.  Considering just holding for a couple weeks and then doing a little water taper down to zero from .045 to 0 over a couple weeks.  But honestly, even if I don’t stabilize, do I even have many other options?  I’m VERY close or maybe at my jump dose.  TIA.

Well, I do think in your case you can consider updosing if you feel too sick. If you’ve been following my posts you would know I usually don’t recommend it at these low doses but in your case I think it’s pretty clear your symptoms are caused by a too fast taper. From what I’ve observed on here generally updosing tends to work if you’ve tapered too fast. However if you’re functional and managing your symptoms even though you might be feeling terrible, then holding might be the better option. I would definitely not jump or taper further until I’m stable. The good thing is you were doing pretty well before this hurdle so hopefully it will level out soon. 

[[Ma...]]

14 minutes ago, [[j...] said:

From what I’ve observed on here generally updosing tends to work if you’ve tapered too fast.

If I did this, to the last dose I did ok with (.062)? My inclination is to hold and see what happens the next few days but I might consider an updose if things seem to be getting worse.

 

Edit:  I know you can’t give specific advise about a dose, just curious about where people who are successful updosing generally try to go back to. 

Edited November 23 by [Ma...]

[[je...]]

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

If I did this, to the last dose I did ok with (.062)? My inclination is to hold and see what happens the next few days but I might consider an updose if things seem to be getting worse.

Edit:  I know you can’t give specific advise about a dose, just curious about where people who are successful updosing generally try to go back to. 

Yes, usually people go back up to the last dose they felt stable at. 

[[Li...]]

Hello @[Ma...]. I’m sorry you hit a rough patch.  Perhaps of interest as you seek to understand what may have happened …

Quoting from Horowitz and Taylor (2024) on the pathophysiology of psychiatric drug withdrawal (pp. 16-17):

 

“During ongoing administration of psychiatric drugs, as with other drugs acting on the central nervous system, neuroadaptation establishes a new homeostatic equilibrium, in which the system accommodates to alterations produced by the drug.”

“When a psychiatric drug taken long-term is reduced in dose or stopped, the homeostatic equilibrium that had been established is perturbed. The difference between the ‘expected’ level of activity by the system and the actual ‘input’ by the drug is responsible for withdrawal symptoms.”

“Withdrawal symptoms will persist for the time taken for the brain to re-adapt to lower levels (or the absence) of the drug — that is, the time taken for a new homeostasis equilibrium to be established.”

“… while the onset of withdrawal symptoms is strongly determined by the elimination half-life of the drug (shorter half-life, quicker onset), the duration of withdrawal is determined by the plasticity of the system in returning to a ‘pre-drug’ homeostatic equilibrium.”

3 hours ago, [[M...] said:

I agree, my taper was faster but I was basing it on how my symptoms were and they were “ok” overall.

Am I understanding correctly from your History that you made reductions at one-week intervals over the past 7 weeks?  If so, given the relatively long half-life of clonazepam, it’s possible that cumulative withdrawal effects were superimposed on one another.  Moving forward, you might consider a longer interval between reductions. Or, if you elect to make smaller reductions on a more frequent basis, you might consider including periodic holds to give your system sufficient time to fully ‘register’ the impact of the preceding series of reductions.

 

[[Ma...]]

Thank you @[Li...].  I’m basically AT the end now so there isn’t much “moving forward” left anymore…lol.  I was only planning on one more cut to like .03 before either jumping or doing a liquid taper to 0.  .025 is the recommended jump for Clonazepam.  But yes, I will probably hold at .045 for at least another week.  

[[Li...]]

You’re welcome @[Ma...].  I hope the hold works for you! 

fwiw .. per Horowitz & Taylor (2024, p. 394), GABA-A receptor occupancy at 0.125mg is approx 9.2%.  At 0.045mg, it’s approx 3.5%.

 

[[Os...]]

I’m in a very similar place as you, with valium. I’m at the end of my taper, and I am making 20% cuts every couple of weeks. And they’re hitting me about a week into each cut. But, I did stabilize after the last cut. And I’m in a hard part of my recent cut. I’m trying to give it time, knowing that I can tolerate this. It feels so frustrating to be having a hard time at this stage. But, based on the Maudsley book (I’ve only seen references posted here, notably the chart about GABA reception), this is the hardest part, as the cuts have more of a GABA effect. Just know that you’re actually spreading out the acute phase, letting your brain get used to lower dosage before your jump. Take your time with this stage. I am. You might not fully stabilize here, but you’re softening your jump. Give it time. You’ve made it this far!

[[Ma...]]

47 minutes ago, [[O...] said:

Just know that you’re actually spreading out the acute phase, letting your brain get used to lower dosage before your jump.

Agree.  This is why I don’t like it when people use the term “acute WD” for what happens when you jump because honestly, this whole process to me is acute WD and the majority of people you talk to don’t experience anything worse once they jump.  I actually came across a long thread on Reddit that addressed this yesterday which was reassuring.  For MOST people who taper to an appropriate jump dose, the step off is just like any other cut without SIGNIFICANT worsening of symptoms.  In essence, it’s not some new kind of WD that’s completely different than the WD they experienced during their taper. 

Edited November 24 by [Ma...]

[[pi...]]

1 minute ago, [[M...] said:

Agree.  This is why I don’t like it when people use the term “acute WD” because honestly, this whole process to me is acute WD and the majority of people you talk to don’t experience anything worse once they jump.  I actually came across a long thread on Reddit that addressed this yesterday which was reassuring.  For people who taper to an appropriate jump dose, the step off is just like any other cut without worsening of symptoms.  

I referred to this term based on my experience. I did not have a textbook taper and now that I know more, it was too fast. I was ok-ish during my taper. I had a honeymoon of sorts once I jumped off for a week or so. After that the bottom fell out and I was in acute with symptoms that were severe and more numerous. We all have different experiences with this process, that’s what makes it so difficult to predict what someone might experience.

[[Ma...]]

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

You’re welcome @[Ma...].  I hope the hold works for you! 

fwiw .. per Horowitz & Taylor (2024, p. 394), GABA-A receptor occupancy at 0.125mg is approx 9.2%.  At 0.045mg, it’s approx 3.5%.

Yes, someone was kind enough to send me this chart.  It did get me to thinking though, is this receptor occupancy curve based on blood concentration or is it based on the dose someone is taking?  Because those are 2 very different things.  Someone taking a dose of 0.5 V has a much higher number of occupied receptors than someone on a comparable dose of Clonazepam or Lorazepam.  The full effects of going to 0 will not be felt for weeks.  I addressed this in an earlier post in terms of the fact that for benzos with longer half lives and higher fat solubility, the actual amount in your body is a lot more than what your dose is when you jump off.  For Valium in particular, it’s on the order of 5-10 times this because of how it builds in your system.  So when someone jumps off of 0.5 V, they actually have a much higher concentration (and presumably much higher receptor occupancy level)  This is why I think going as close to zero is probably the best plan.  Sorry for the long post but I felt it was important to address.

 On another note, I slept great last night and feel great today, so maybe the last 2 days were just a blip and not a start of some long wave.  

Edited November 24 by [Ma...]

[[Ma...]]

28 minutes ago, [[p...] said:

I had a honeymoon of sorts once I jumped off for a week or so.

I think this is pretty common.  I’m not sure what you jumped from or which benzo.  Nevertheless, based on the Reddit thread I referred to above and the many people I’ve discussed this with on here @[Ro...] @[je...] etc, the step off for many, probably most is no worse than the taper they’ve already been enduring if they jump from a low dose.  It’s not some entirely new type of WD different than what they’ve already been experiencing.  Just trying to give people some encouragement about jumping, while grounding it in some reality that we are all different. 

Edited November 24 by [Ma...]

[[pi...]]

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

I think this is pretty common.  I’m not sure what you jumped from or which benzo, but yes it is somewhat unpredictable.  Nevertheless, based on the Reddit thread I referred to and many people I’ve discussed this with on here @[Ro...] @[je...] etc. the step off is no worse than the taper.  Just trying to give people some encouragement while grounding it in reality that we are all different. 

I didn’t find BB or any information other than the Ashton manual when I knew I needed to get off the drug. My doctor was willing to learn but neither of us really understood the process. I simply cut 1/4 of a pill every week or so. You can see that the percentages were high. I tapered from Valium. This is likely why I was hit so strongly after I jumped. 

[[Ma...]]

1 minute ago, [[p...] said:

I didn’t find BB or any information other than the Ashton manual when I knew I needed to get off the drug. My doctor was willing to learn but neither of us really understood the process. I simply cut 1/4 of a pill every week or so. You can see that the percentages were high. I tapered from Valium. This is likely why I was hit so strongly after I jumped. 

Yes, that makes sense.  It sounds like you have healed which in the end is all that really matters.  😎

[[Tr...]]

I will quote from the book of M. Horowitz and D. Taylor in case Matt or other buddies, who are also currently tapering Clonazepam, would like to have some more information on Receptor occupancy.  According to the Maudsley Deprescribing the Receptor Occupancy (%) and the TDD (mg) for the lowest TDD of Clonazepam are as follows:

RO (%)   TDD (mg)

3.9           0.05

3.1            0.04

2.4           0.03

1.6            0.02

0.8            0.01

 

Edited November 24 by [Tr...]

[[Tr...]]

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

On another note, I slept great last night and feel great today, so maybe the last 2 days were just a blip and not a start of some long wave.  

This is great news! Fingers crossed that your will continue feeling good! 🍀🍀🍀

Edited November 24 by [Tr...]

[[Ma...]]

5 days later.  Not feeling any better or worse.  Kinda up and down all day.  I’ll feel fine for an hour or two and get things done, go to the gym, etc.  Then an hour later feel like I need to lay down a while and can’t be around anyone.  It seems crazy, but I guess I’ll just hold on this really low dose (.045) another week or two.  If that doesn’t work I don’t know what I will do.  I know I had been doing weekly cuts which is frowned upon, but for me that had been working up until now.  Our tapers are supposed to be symptom based which is precisely what I was doing.  I don’t think updosing is the answer but I definitely am feeling a little “stuck” right now.  

Edited November 27 by [Ma...]

[[Tr...]]

Hi @[Ma...], I am so sorry to read that you are feeling up and down. I think that your plan to hold for a week or two is reasonable. Perhaps also try not to go to the gym for a certain period of time. 

 I hope and pray that the sxs will subside and you can go down to 0.025 mg and jump off uneventfully!  🙏❤️🍀

Edited November 27 by [Tr...]