planning V taper

[[ca...]]

Hi Everyone, 

I hope you are doing well or at least making it through ok. 

I had a quick question and wondered of anyone has run into this.

I Have found that going down 1 mg every 4-6 weeks is best for me. With this method, I have gone from 40m mg V to 25 currently. I went to 25 last week. My only medication is Valium.

It seemed my prescriber was supportive of allowing me to listen to my body and do cuts where I felt ok. So I'm doing 10 am, 7mg afternoon, 8mg night.( I was doing 8mg afternoon, 7 mg at night but switched it per prescribers request 5 days ago- boom anxiety hit!)

The prescriber is insisting ( even borderline rude) that I remove afternoon dose and wants me to go to 5 mg afternoon, and 10 at night. ( that still keeps daily dose of 25mg, I do understand) I do understand the rationale for removing afternoon dose but they don't seem to understand the therapeutic effects of the medications, vs the half life. They kept saying, its in your  system for 100 hrs, you'll be fine.

However, since I even moved to 7 ( not 8 in afternoon , I can feel significant anxiety) Every little change affects me.

Prescriber seems insistent that I move to 5 mg in afternoon almost immediately and I don't  understand why if I'm still doing 25mg/day

Plan would be to go 24 next after 4 weeks our so.

This seems odd to me. Why would it matter as long as im moving in the right direction?

This would, give me 2 weeks to go from 7 to 5 mg in afternoon with how they would be prescribing. 

 

Any feedback would be greatly appreciated

Cali

 

Any suggestions of how I could approach prescriber on this? They brought up psychological dependence and seemed aggravated with me last meeting, so now I'm fearful of bringing anything up. 

[[Pa...]]

What odd behavior from your prescriber, I don't think I've seen one get so involved as to dictate times and doses so stringently. Yes, they typically care about the amount, because that is what they're legally responsible for but this, this just seems like an unnecessary attempt at control.  

Question @[ca...], can you keep the schedule most helpful for you and not tell your prescriber at what time you're taking your doses?

[[ca...]]

Hi Pamster,

thank you for your reply. Its validating to know you perhaps feels this is odd too.They were borderline annoyed that I questioned it politely. 

 

 it would not be possible to do without certain mg dosages. Valium comes In 10, 5 and 2. I would need 2's to do what I'm  doing successfully.

I truly don't understand the reasoning.

 

Cali

 

 

 

 

[[Pa...]]

Hey @[ca...], I wonder if your prescriber has been talking to someone about your case, they may be getting pressure from someone else in the practice.  It seems many physicians are getting nervous about benzodiazepines which is a good thing in terms of less prescriptions but ripping people off their medication is a consequence of their discomfort.  

It sounds like you're cutting your pills so the dose sizes are important, but if you decide you need to move to titration to accomplish tapering your way, let us know and we'll help you figure something out. 

 

 

[[ca...]]

HI,

Thank you for your reply. 

They own the practice, so I don't think that's why. it's certainly odd.

Has anyone else had increased symptoms with even small dosage changes during day 

(with same daily dose)?  It is " more typical" to remove middle dose to keep levels similar  across the 3x/day dosing? There is a difference  between half life and therapeutic effect. I would think a prescriber would understand that. It's chemical anxiety I'm feeling, which has be from this last change.

Ive taken it 3x/day for 4 years, and they seem dead set on removing the middle dose. 

I understand , in theory, but as long as I'm moving forward, I sent then making more changes was advisable for me. I do best with changes when I feel better than this. I'm typically without any major symptoms.

 

Any suggestions on this to approach them ?

as I will not have the correct doses pills to continue where I am t avoid any further upset to my system? 

 

Thank you!

[[El...]]

@[ca...] I agree...the process that your doctor is suggesting/has suggested is quite odd!

I am not sure what your preferred dosing schedule would be for your next reduction.  But, irregardless of the mg dose of pills (5mg or 2 mg), would it be possible for you to cut and weigh your pills to achieve the dosage that is most comfortable for you?  I am on Ativan.  My doctor also wants me/thinks I should be on 2 doses per day.  But I have just carried on with my 3 doses...first by cutting and weighing my pills (the sum weight of doses is just divided by 3 rather than 2), now doing the same but with the liquid.

Is that a possibility?

[[Bi...]]

@[ca...] I have been prescribed Valium for 8 years. Daily 5mg. It has been sheer hell trying to shift. I spent five months of this year non functioning due to rapid cuts that were quite haphazard. I have since learnt better and listen to my symptoms. All this is to say (with Valium at least) that I do think small shifts can make a big difference despite the long acting/half life of the drug. And if you are finding it to be the case, your body already knows better than any proposed schedule.

I have kept a record for sometime, and interestingly, it is around day 17 when symptoms start to somewhat lesson after a cut. That is effectively the full life of that cut. Of course each persons body metabolises differently etc. given my dose remained the same, I have been in withdrawal tolerance for a few years. 
Is your prescriber your long term doctor? Do you have repeat scripts, or need to go in regularly? It’s a tough one. I think the added pressure of a schedule that is not yours adds to the stress of an already challenging scenario. 
Is there a different doctor you can go and see? 

[[ca...]]

HI,

Right now, my preferred doing would be to stay with what I'm doing  bc of the chemical anxiety I have due to shift they had me do.

Cuurent: Which is 10 mg am, 7 afternoon, 8 bedtime ( still 25mg/day, so I don't see their issue).  Fairly even dosing

There is info on Benzo coalition site saying mostly equal dosing several times a day seems best to keep blood serums levels to her even, which, to me, make sense. And has worked for me to do it that way. 

Yes, the appts are month to month and written in a way where Im stuck. So I have no options but to try and speak to them again and help them see what I'm saying/ need. 

Do folks think I should email what's happening and what I would like/need  or try to get appt this week? This prescriber brought up the " psychological component" of tapering this past visit, so I know they don't get it. It's my body reacting, not my mind. But I'm sure you all know how that all goes. ( eye roll )

Yes, Absolutely, this situation isn't helping anything with anxiety as it's a pressing issue. 

I"m so sorry you're stuck on 5, but you're doing great and made it really far. Even if you hold for awhile. 

 

I don't know, but is it  difficult to find prescribers who are willing to let patents responsibly decide how they feel? I have consistently reduced, never updsoed and am not on other meds. I habve never abused any medications. ( like the majority)

 

ugh

 

cali

 

 

 

 

 

 

 

 

 

[[Bi...]]

I hear you. Most people have simply taken what they were prescribed, however when time to stop and withdrawal symptoms are experienced, terrible and incorrect terms can be used and felt - as though there is a “drug problem”. I believe that is the ignorance and inexperience of the practitioner. 
It is the same as the “psychological” comment. While that can exist, if you believe that is not the case, then that is the truth and reality. My symptoms have been so neurologically and physically severe, that before I realised it was withdrawal, I ended up having every cardio assessment possible, consulted with a cardiologist, neurologist, and ENT. All I had to fly interstate to see. The GP had me believing I had multiple physical conditions going on, not making the timeline link with withdrawal (given not a single issue existed prior). 

It is tough feeling stuck. Have you read the Ashton Manual? Also, the Maudsley Deprescribing guidelines is about 70AUD on Amazon etc. it offers great medical explanation (for doctors) on the patient experience. It specifically covers the “it’s all in your head” and non acknowledgment of symptoms. I suggest looking up Dr Mark Horowitz who is the co author. He has lived experience and IS a psychiatrist. 

also, there is an advocate called Dr Jenn. This is her site. She has some great content, and also has free template letters for the doctor. 

Pick and choose which resources suit you, however these (if you haven’t seen/read already) could be a good start. 
 

which country are you in? I don’t want to assume USA through your name! 😊
 

[[ca...]]

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

I hear you. Most people have simply taken what they were prescribed, however when time to stop and withdrawal symptoms are experienced, terrible and incorrect terms can be used and felt - as though there is a “drug problem”. I believe that is the ignorance and inexperience of the practitioner. 
It is the same as the “psychological” comment. While that can exist, if you believe that is not the case, then that is the truth and reality. My symptoms have been so neurologically and physically severe, that before I realised it was withdrawal, I ended up having every cardio assessment possible, consulted with a cardiologist, neurologist, and ENT. All I had to fly interstate to see. The GP had me believing I had multiple physical conditions going on, not making the timeline link with withdrawal (given not a single issue existed prior). 

It is tough feeling stuck. Have you read the Ashton Manual? Also, the Maudsley Deprescribing guidelines is about 70AUD on Amazon etc. it offers great medical explanation (for doctors) on the patient experience. It specifically covers the “it’s all in your head” and non acknowledgment of symptoms. I suggest looking up Dr Mark Horowitz who is the co author. He has lived experience and IS a psychiatrist. 

also, there is an advocate called Dr Jenn. This is her site. She has some great content, and also has free template letters for the doctor. 

Pick and choose which resources suit you, however these (if you haven’t seen/read already) could be a good start. 
 

which country are you in? I don’t want to assume USA through your name! 😊
 

My gosh, you've been through the wringer, I'm so sorry. What IS  crazy is doctors not understanding much of this. Dr Jenn, sounds great though. Did you by chance have the link to her content?

Yes, I'm the USA  I'll look at the deprescibing guidelines too. Ive seen the Ashton- it was why I switched to Valium from Klonipin. I thought the varying dosages available might be helpful to taper. They would be if prescriber presciberd what I feel is best for my body. 

 

errgg

 

Cali

 

 

So, you're not feeling well then. is it advisable to update or will it pass? Ive read horror stories but I do know that (or I think) that most people get out okay

 

[[Bi...]]

Sorry, yes - can’t insert link at moment. You can look up ‘benzowithdrawal.com’. Resources are in the top right. I enjoy her YouTube videos. Also, Angie Peacock if you haven’t heard of her. I watch her videos on repeat when struggling. 

I am now functional but still continue to have significant non functional waves. I got onto Mark Horowitz and the Maudsley deprescribing, and have (and still am) working through best taper strategies. I am learning to listen to my symptoms. I do believe we recover and heal. Patience is the hardest part, but is the key. I had tried rushing through.

is there another doctor you might be able to meet with and discuss? Any word of mouth referrals through people you know? It is hard when not supported. Thank fully everyone is here at the community! 😊
 

 

[[ca...]]

Hello,

Does anyone have any links to information I could show my GP to see if perhaps they could take over? My understanding is approx 5% of total dose is what's currently recommended to decrease ( Give or take based on individual) to go down by every 4 weeks or so. I had ben on ben xo 20 years, so long time. I willingly decided to taper. 

With valium, there are many different mgs ( they have 10, 5 and 2's -which should be a plus)

I think I would  would need 30 10's, 75 2's and 60 5's- Math is not my strong suit.

To keep at 10 mg in morning, 7 in afternoon and 8 at night.  I think my math is correct? anyone good at math?  I think I need to stabilize on this dose before doing anything else. I just went to 25 mg Dec1 so it has not been very long. Just not sure not sure how to present this to my GP. My current prescriber is set on eliminating middle dose, which I dont agree with at all due to my diffculty in truing to do so. They are not open to anything.

Thank you all

 

Cali 

[[Pa...]]

Hi @[ca...], I'm not sure what you're asking for, but there is good guidance in this document, plus its fairly brief so doctors may be more amendable to reading it.

Benzodiazepine Deprescribing Guidance

The Maudsley Deprescribing Guidelines is excellent , it can be purchased on Amazon, it covers Antidepressants, Gabapentinoids and Benzodiazepines. 

[[ca...]]

Hi Pamster,

That is exactly what I was looking for! I only need for benzos so this will be fantastic to show a provider. I agree, a less cumbersome reading is best and more likely they will have the tine to read. Thank you so much.

 

I know folks have had trouble even with reductions on one of daily doses while maintaining same daily dose. ( ex; total dose 25 mg/day) I currently do 3 doses a day- totally 25 mg- my prescriber doesn't believe I could have symptoms from that because of Valiums' " half life". I understand Valium stays in our system for a long time, however, I doing know how to explain that any change affects my highly sensitive nervous system. My prescriber is insisting I remove middle of day dose, so I moved to a slight shift of 10 am , 7 afternoon and 8 at bedtime and even that wreaked havoc. My concern is prescriber will think this is psychological, which it is not.  

Cali

 

I really appreciate you all !

 

 

 

[[Pa...]]

I hope your doctor takes the time to read the guidance @[ca...], you're an adult, I don't understand your doctors behavior.

The psychological aspect of reductions is a thing though, its certainly a component of this process but it takes a backseat to the actual physical and mental symptoms we experience.  There are some people who are doing a blind taper in order to avoid the psychological aspect however, their symptoms prove its a fallacy to assume our misery is purely psychological.