Penstemon: Simultaneous polydrug tapering

[Skyler]

 I am wondering what you think about me dosing my temazepam during the night in addition to the bedtime dose. Not increasing but splitting it in some manner. The reason I ask is that I awaken EVERY SINGLE MORNING(and have for a very long time-before I started tapering it)with severe depression,anxiety,intrusive thoughts, and dread. It sets up the rest of my day for failure and is excrutiating to try to overcome. I dose the Ativan every 5 hrs during the day then go from 9:30pm to 6:30am on just the bedtime dose of temazepam. I know that mornings tend to be rough for most of us in w/d but this seems to be an obvious thing to try. Any thoughts on this?

 

Penstemon, as we discussed in the benzo forum, you are symptomatic because of interdose WD. Taking a dose of Restoril in the middle of the night should help, but you may need to even out your doses more than this.  Taking Restoril dividing the nighttime dose so you take it once in the middle of the night is a good first step.  Merging the two benzos so you are only taking one would constitute a change.

[Rhiannon]

I think it's possible you're getting an interdose withdrawal effect from your benzos.  It's possible the temazepam at night isn't substituting for the Ativan that you aren't taking during that longer extended period. I can't say for sure, but generally it seems to be best, with short-acting benzos, to keep the blood levels as smooth and even as possible.  

 

I don't have much experience with temazepam. It appears to be fairly short-acting, so it's possible to get interdose withdrawal from it too, I expect.

 

It's up to you. In your shoes I would probably give the split dose a try, although I might wait until I were feeling a bit more stable overall before changing anything. Right now your morning cortisol is probably contributing to your bad mornings, so it might be a little harder to figure out what the change in temazepam is doing.

 

(Actually my own preference with any benzo is to not take it just once a day, except Valium; I lean towards splitting them all up into even doses at even time intervals, based on how fast they break down, to keep fairly even blood levels over 24 hours. But I can see that would be tricky with something very sleep-inducing.)

[Rhiannon]

Oh, I posted that before reading Skyler's post.

[Penstemon]

thanks to all of you for your help.Please note that I made an error when I said that my 2nd cut was 2%. It was only 1%. But I intend to take your unanimous advice and hold until I can get some stability. I am going to try dosing temazepam during the night in addition to bedtime in hopes of lessening the interdose w/d.I need to also point out that in November 2012,my doc changed my Ativan script from 1mg tabs to .5mg tabs and I did not realize it for quite some time.Not knowing exactly what I was doing, I updosed in May by .5mg a day. My point being that this messing around with Ativan dosing may have set me up for some nasty delayed sx's.wish I had found you guys sooner!

[Penstemon]

Rhi or anyone on 2 benzos- are you saying in your previous post that you like dosing both benzos throughout the day-as in taking more than one benzo at a time? or just splitting the doses evenly based on their equivalencies? can you be more specific please? thanks much. hope you are doing well.

[Rhiannon]

Pens I'm on xanax and valium and I only dose the valium once a day and the xanax every three hours. But if I were on two short-acting benzos I would dose them both multiple times per day. They aren't interchangeable.

[Penstemon]

Thanks Rhi. I think I finally get it. I hear a lot of talk about equivalencies between benzos-but it makes more sense to me that they are not interchangeable-each benzo is different and my brain has adapted to what I am on.

[Rhiannon]

Thanks Rhi. I think I finally get it. I hear a lot of talk about equivalencies between benzos-but it makes more sense to me that they are not interchangeable-each benzo is different and my brain has adapted to what I am on.

Right.

 

The concept of "equivalencies" comes from Heather Ashton, who was a pioneer in benzo withdrawal from the 1980s through the early 21st century.  

 

Her method for tapering people off of shorter-acting benzos was to transition them to Valium instead, because of its longer activity and long-acting metabolites.

 

She would transition someone off of a short-acting benzo like Xanax or Ativan and gradually onto Valium instead, over a period of many weeks, and then have them taper off the Valium. This is what people mean by the term "Valium crossover."

 

The equivalencies that we talk about are the doses that she found in her practice seemed to be what worked for these crossovers. So, for example, she would taper someone slowly off Xanax and onto Valium at a ratio of 20 mg Valium for every 1 mg Xanax, and that seemed to be about the amount that was needed.

 

So that's where the concept of "equivalencies" comes from. It's not a pharmacological concept. I don't think it's backed by any kind of controlled clinical trials. And it doesn't mean that different benzos are interchangeable in daily practice.

 

The Valium crossover has worked for thousands of people, but it doesn't work for everyone.  Some (like me) have a bad reaction to Valium. Others just find that they can't cross over, they get too symptomatic from withdrawal off their short-acting benzo even with the addition of Valium.

 

Since the advent of the Internet and the withdrawal forums, people have developed ways to taper directly off short-acting benzos (multiple daily doses usually with liquid titration).

 

So there ya go--benzo withdrawal history lesson!

 

:-)

[Altostrata]

Great post, Rhi. Deserves to be one of our benzo forum tapering nuggets.

[Penstemon]

excellent Rhi! thanks much!

[Penstemon]

I have been holding on my tapering for ~ 5 weeks. I don't plan to make any cuts for awhile but would like to even out the dosing of my 2 benzos and would appreciate advice on how to approach it Current dosing of benzos:

 

temazepam: 6.82mg at 9:30pm/ 2:30am used to dose at bedtime only for sleep.

Ativan:  .470mg at 6:30am/ 11:30am/ 4:30pm

A to T equivalency is 20:1 so I am getting the bulk of my benzo during the day and very little during the night.

 

As I have mentioned before, I awaken to horrible depression and anxiety every morning and have since before my taper began.

I am considering dosing both benzos 5x/day-perhaps both at the same times. But as there are a myriad of ways to dose them, I am just not sure of what to try first.

 

I take 2 other drugs for sleep-Seroquel and trazadone and just don't know what the temazepam is doing for my sleep at this point or if it will make me drowsy during the day(been taking it 14 yrs and have reduced my dose by greater than a half. I won't know until I try it. I am not working so daytime drowsiness may not pose a problem for me should it happen.

 

Also wondering(for ease of administration and minimal sleep disruption) if it is okay to put both benzos into one syringe for middle of the night dose.

 

Rhi-I know that you take 2 benzos and hoping that you might have some thoughts to share.

 

Thanks so much and hope that all is well with all of you, Pati

[Altostrata]

You may wish to visit this forum http://survivingantidepressants.org/index.php?/forum/29-members-only-benzo-tapering-discussion/

[Penstemon]

Thanks Alto. I have looked that over a lot, but I don't find any that are trying to get stable on 2 benzos. Hopefully Rhi will chime in.

[Penstemon]

I have a plan in place now so don't need advice on this topic afterall.

[Rhiannon]

Let us know about your plan and how it goes.

 

I was going to suggest that you dose the Ativan around the clock rather than leaving the long break at night, since you're having a hard time in the mornings.

 

Actually if it were me I would dose both benzos around the clock, equal doses at equal time intervals, to try to keep blood levels of each drug as smooth and level as possible.  Remember, they're not interchangeable.

[Penstemon]

Thanks Rhi. I am a bit afraid that I might really disrupt my sleep if I divided my nighttime temazepam into 4 doses instead of 2. Was thinking of just adding a dose of Ativan so I would be doing 6 benzo doses in a 24 hr period. 4 of A during the day and 2 of T at nighttime. But I think your idea has a lot of merit too. Damn-it's so hard to know what to do.

[Altostrata]

Please continue this discussion in http://survivingantidepressants.org/index.php?/forum/29-members-only-benzo-tapering-discussion/

[Penstemon]

I really need some help please. I have been tapering and come off of various drugs for 3 years now without any substantial breaks. Some were tapered Breggin style, others faster.I found this group and others in May 2013 and learned how to taper more safely. I still have 4 drugs including 2 benzos to get off of.

 

My depression is extremely severe as is anxiety. I would say that it has gotten steadily worse since ~ April. I am nearly non-functional, although I do have occasional small windows. The waves are intolerable, suicidal thoughts are common.

 

My question is: do I need to take a long break from tapering? Might that help me? Or should I just keep hoping that getting the poisons out will help more? I know that there is no magic answer but would like to hear some thoughts on this. Thanks so much.

[Meimeiquest]

Do I understand you correctly that you've done various kinds of cutting since July through variable, but increasing, symptoms? If it was me, I would stop till I felt much, much better. Well, actually, I am doing that . Your brain has been through so very much!

[Skyler]

I agree with Mimequest.  HOLD that taper!  The idea we don't get rid of the toxins until the drug is out of our system is a misnomer. As long as your body is in WD, the effect of the drug is 'as if' it was there... our bodies need time to reset the neuroreceptors the drugs altered.  So, by tapering at your current rate.. your body will be acting as though the drug is present longer.

 

Your body is sending you a signal.. so be good to yourself and take a break.  I just held for many months.. now I'm tapering again, and feel better for the hiatus.

[Penstemon]

yes Mimequest.infact,I have done a number of tapering methods/rates throughout my 3 yrs of tapering.it's a pretty cloudy picture and likey that some of the rapid tapers I did eventually caught up to me. which makes me ponder if I will ever get out of this hell.maybe this IS my "stable" or baseline.I just have no way of knowing but perhaps a long hold might help me determine that.

 

thanks Skyler for that insight. makes a lot of sense. very glad to hear that your long hold helped and that you are feeling better!

[Meimeiquest]

I've read in 2 places (does that make it fact?) that one should expect it to take a year to get off a psych drug one has taken for over a year...and that's average, not those of us at the edge of the bell curve. By that expectation, you're way ahead of schedule .

[Penstemon]

thanks Meimequest! ahead and paying for it!

[Marie]

I know nothing of the ADs and how long it takes to recover from them if taken over a year. It's very much out of my element and knowledge base.

 

But I have read in several places that it takes a month to recover from each year on a benzo. That's been written on several sites, and some no longer active but with "FAQ " type info left to see. It's most likely a general guideline as it's all so individual, I think some of this is all over the bell curve of the supposedly "limited" people who have trouble with all this stuff.

 

That right there is a discussion for another thread, and maybe it's already been discussed here as I've surely not looked through this whole site.

 

But I surely think a good hold could definitely help you. Your sx show your receptors and CNS are in a state of flux, change, uncertainty. A hold will give you a chance to rest physically and mentally, and get that stability to carry on later when you are ready.

 

Marie

[Meimeiquest]

Pen, It really doesn't matter what anyone else needs...it's a great opportunity to take care of the unique you...something I think most of us who ever "needed" these drugs gets to learn through the process of withdrawal.

[Skyler]

I've read in 2 places (does that make it fact?) that one should expect it to take a year to get off a psych drug one has taken for over a year...and that's average, not those of us at the edge of the bell curve. By that expectation, you're way ahead of schedule .

 

Hi Marie and Meime.. a number of factors affect the length of time it takes to get off a drug...including the length of time on a drug, age, genetics, the presence of other psychotropics, and lastly.. and most importantly IMO, the drug history.. the presence of a previously difficult WD.

[Penstemon]

I'm pretty sure I know what the advice will be but am needing some reassurance. I get so much anxiety going each time I contemplate making a change. As you can see from my signature, I have been tapering various drugs for nearly 2 and a half years. As you can also see, all of them have been rapid tapers.

I have been trying to find some stability since discovering the online groups 14 months ago.  But it's just not happening. I have had 3 periods of holding for two months. I have updosed my benzo. I have crossed or merged my two benzos to one. I have forged ahead with microtapering despite bad w/d sx's. Nothing seems to change my ongoing state of misery from mostly mental sx's. I have no patterns to my sx's. They are pretty much constant and unbearable with occasional small windows. I am barely functional and cannot continue on like this.

The one thing that I have not done is hold for longer than 2 months. At this point, I am feeling like I need to try a very long hold as Rhi has suggested in the past. I'm sorry that I didn't take her advice then. So I am thinking of holding all my drugs for 3-6mos, maybe longer, to see if I can calm down some of the chaos that has taken hold of my body and brain.I would love to hear from anyone that has been able to pull themselves out of a bad taper by holding and then going on to a more "comfortable" taper.

I know that there are no guarantees in this tapering/wd process, esp with my messed up history, but I sure could use some encouragement right now.

Thanks for any and all advice. Wishing you well.

[Meimeiquest]

If you can, there is an amazing clinic in Ft. Collins, trilifehealth.com. One of the docs was once the chief medical officer for NASA and decided there had to be a better way. I travelled to Chicago when I felt somewhat like you describe (although not as bad). I have been happy with them so far...mensahmedical.com. But holding is a great idea too...I think you've proved to yourself that just trying incredibly hard doesn't always work.

[mammaP]

Hi Penstemon, I've merged the new topic with your introduction thread because it is an update 

and questions about your multi taper. 

 

A long hold is sometimes the best way to go, it will give your nervous system time to stabilise.

If you push through a taper while having withdrawal symptoms the CNS and brain has no time

to catch up.  I think you are right to consider a long hold of several months or even longer.

I tapered too fast and have been holding for a year, with a brief period where I took a cut then

updosed again because my body just wasn't ready for it. 

 

When you have stabilised and been stable for a few months you could restart your taper but I 

would hold longer between cuts. We all want off the drugs in the shortest time possible but

sometimes trying to do it faster ends up taking twice as long because our poor brain struggles to

keep the pace! 

[Rhiannon]

Pen, you know I've thought you were rushing things all along and that you needed a good long hold a long time ago.  I still think you need to get more realistic about how long it's going to take to get off these meds and how to go about it.

 

I think a long hold is still a good idea for you but frankly at this point I think even six months is going to be short as far as actually stabilizing and getting some resolution of symptoms. You probably need to be thinking six months to a year, not switching meds around during that time, no "quick fix" attempts. You'll continue to be symptomatic and you have to quit thinking that you can change something and fix that every time it happens. As you can see, the problem is more complex than that and your fixes just destabilize you more.

 

So yes of course I think a long hold is in order. I think you also need to adjust your expectations and your approach. I think a major change in your approach is the thing that will do you the most good.

 

In answer to your last question, yes, long holds have a pretty good track record, but it gets less predictable the more complicated the drug history is.  In my own very slow and regulated taper, when symptoms get so bad they're getting in the way of doing the things I need to do in my life, I do a long hold, and it seems like about three months is the magic time period for me when I start to feel really good. But that's not transferable to your situation. I guess what I'm saying is yes, it works for me, I've seen it work for lots of people, but your situation is pretty complicated with all the things you've been changing around.

 

My best guess is that a very long hold would be good for you too, but I can't predict with a high level of certainty or confidence, in your case, how long that hold needs to be and how long it will be before you see improvement.

[Penstemon]

MammaP,  thanks for your comments. You stated that you "tapered too fast and have been holding for a year". How has that long hold worked out for you? Were you in bad w/d when you started the hold? If so, how long did it take for you to get some relief from your sx's? I understand that we are all different in our journey's and trying to extrapolate from another's experience may not be helpful. Nonetheless, I am curious about your story.

Rhi, thank you for your timely and candid response. I want to follow up but am waiting for my brain to engage a little more. I have so much trouble formulating then writing thoughts.