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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Paul Smith on June 15, 2005, at 17:00:10
I have done the whole gamet, Ashton Manual, forums, you name it, slow taper, cold turkey. Unfortunately, unlike most, am not a housewife with enough support and resources to suffer for years without working. Valium is a middle to upper middle class drug. I had to gamble and go back on, was 6 months off and still a basket case, was plenty functional before an idiot doc put me on Xanax long term for moderate stress. I have Valium, can get it, no way in the world I can taper again. I went back on to try and stay off the streets but still cannot work, felt better for about a month then it pooped out. Any suggestions. Cold turkey hell, the grim reaper and dragons in my room as I gasp for air? State rehab if I can get in (have no insurance) where a lot detox you off Valium with Ativan. Is like detoxing a whisky drinking alcoholic with Vodka. Idiots! Any insights would be appreciated.
Posted by ed_uk on June 16, 2005, at 8:02:53
In reply to Valium help, I cannot taper, posted by Paul Smith on June 15, 2005, at 17:00:10
Hi Paul,
>felt better for about a month then it pooped out...
What dose are you on at the moment? What are you current symptoms?
~Ed
Posted by Phillipa on June 16, 2005, at 21:40:52
In reply to Re: Valium help, I cannot taper » Paul Smith, posted by ed_uk on June 16, 2005, at 8:02:53
Valium is usually easier than other benzos to taper off because of the long halflife. Fondly, Phillipa
Posted by Declan on June 17, 2005, at 18:32:41
In reply to Valium help, I cannot taper, posted by Paul Smith on June 15, 2005, at 17:00:10
Well I can't help much. Having been a benzo user from 1972 (I think it was) every day, all I can say is that I've had trouble tapering too. By this stage a couple of things are almost hardwired into me. Firstly take the minimum and take it a little later than desired. Secondly take nutritional stuff and herbs to sometimes replace or supplement the benzo. Thirdly exercise. (This is important and I have been completely unable to so far this year). In the 70s benzos were very liberally Rxd, I was young and reckless, so you can imagine the outcome. Yesterday I took 5mg diazepam. It's now 9.30am and I havn't had any more yet, so I'm kinda pleased with myself. That's how I try to handle it.
Declan
Posted by SLS on June 18, 2005, at 8:08:19
In reply to Valium help, I cannot taper, posted by Paul Smith on June 15, 2005, at 17:00:10
You might want to try an experiment. Divide the pills into very small fractions. Take them during the day only as needed. You might end up taking it more than three times a day, but that's the idea. Purposely wait until you begin to experience withdrawal symptoms before you take your next small dose. See whether the amount you end up taking per day doesn't decrease gradually. There's a chance that it will. You don't have to be precise in splitting up the doses, as long as they are approximately the same size. Through experimentation, find the amount that will last 6-8 hours (no longer) before symptoms reappear. This is called flexible-dosing.
- Scott
Posted by SLS on June 18, 2005, at 8:12:24
In reply to Valium help, I cannot taper, posted by Paul Smith on June 15, 2005, at 17:00:10
Here are some of the posts involving flexible-dosing here on Psycho-Babble. Most of them probably have my name attached to them, so it would be prudent to view me as a biased advocate for using this strategy. Most of the posts are related to the difficulties discontinuing Effexor, but I have also seen flexible-dosing work for benzodiazepines.
Search:
http://www.google.com/search?q=flexible+dosing&sitesearch=dr-bob.org
- Scott
Posted by Paul Smith on June 18, 2005, at 18:04:32
In reply to Re: Valium help, I cannot taper » Paul Smith, posted by ed_uk on June 16, 2005, at 8:02:53
> Hi Paul,
>
> >felt better for about a month then it pooped out...
>
> What dose are you on at the moment? What are you current symptoms?
>
> ~Ed37.5 mgs Valium. Burning skin, paranoia, dizziness, world looks surreal, mild tremor, insomnia, agitation, stange sinking sensations when I take steps, weakness, zero apetite. Holy God I have been fighting this insanity for 2 years. And people that have never been through it tell me to go work in spite of it all, to walk with a cane, to "adapt to it" like a quadaplegic does. Please take my legs for this to go away!!! Take my most private part! They have no clue, no one knows this unless they live it. Euthanasia would be the kind thing. What, go to 60 mgs, then a month later 80, up and up? Cross to Klonopin? All the help I can find is 30 day treatment centers to cold turkey me off but would need to scrounge up $1000 for that. Thay are partly govt funded. Would be in there with alcoholics who are loud, eating like horses and talking about getting laid after their 3 day withdrawal. God have mercy on me.
Posted by Paul Smith on June 18, 2005, at 18:07:43
In reply to Re: Valium help, I cannot taper » Paul Smith, posted by SLS on June 18, 2005, at 8:08:19
> You might want to try an experiment. Divide the pills into very small fractions. Take them during the day only as needed. You might end up taking it more than three times a day, but that's the idea. Purposely wait until you begin to experience withdrawal symptoms before you take your next small dose. See whether the amount you end up taking per day doesn't decrease gradually. There's a chance that it will. You don't have to be precise in splitting up the doses, as long as they are approximately the same size. Through experimentation, find the amount that will last 6-8 hours (no longer) before symptoms reappear. This is called flexible-dosing.
>
>
> - Scott
>
>I live in symptoms, they do not disappear.
Posted by ed_uk on June 18, 2005, at 20:49:15
In reply to Re: Valium help, I cannot taper, posted by Paul Smith on June 18, 2005, at 18:07:43
Hi Paul,
When you took Valium initially, before you did the slow taper, what was the maximum dose that you took??
Btw, are you on any other medication at the moment?
>Burning skin, paranoia, dizziness, world looks surreal, mild tremor, insomnia, agitation, stange sinking sensations when I take steps, weakness, zero apetite.
>37.5 mgs Valium.Did you have all these symptoms when you were on 40mg?
>....to walk with a cane, to "adapt to it" like a quadaplegic does.
I wouldn't ever say that to you.
RE what can I do to get well???
One option would be to withdraw the diazepam and have flumazenil infusions in a hospital clinic.........
Please read my post (and the rest of the thread)............
http://www.dr-bob.org/babble/wdrawl/20050228/msgs/473333.html
'Flumazenil (FLU).....significantly reduced withdrawal symptoms in comparison with oxazepam (a benzo) and placebo on both self-reported and observer-rated withdrawal scales. FLU also reduced craving scores during the detoxification procedure. In addition, during oxazepam tapering, group B patients experienced paradoxical symptoms (which may be what YOU are experiencing Paul) that were not apparent in flumazenil patients. Patients treated with flumazenil showed a significantly lower relapse rates on days 15, 23 and 30 after the detoxification week. Our data provide further evidence of FLUs ability to counteract BZD effects, control benzodiazepine (BZD) withdrawal and normalize BZD receptor function. The effectiveness of FLU may reflect its capacity to upregulate BZD receptors and to reverse the uncoupling between the recognition sites of BZD and GABA, on the GABA(A) macromolecular complex, that has been reported in tolerant subjects.'
'Flumazenil has also been proposed as a treatment for protracted benzodiazepine withdrawal, where neurological symptoms persist long after the drug is discontinued. It is thought that flumazenil might be able 'reset' benzodiazepine receptor function.'
Kind regards,
Ed.
Posted by SLS on June 18, 2005, at 21:43:05
In reply to Re: Valium help, I cannot taper, posted by Paul Smith on June 18, 2005, at 18:07:43
Hi.
> I live in symptoms, they do not disappear.Please correct me if I'm wrong, but you are saying that there is no dosage of Valium that will allow these symptoms to disappear?
- Scott
Posted by Paul Smith on June 18, 2005, at 22:50:54
In reply to Flumazenil: an option for Paul??? » Paul Smith, posted by ed_uk on June 18, 2005, at 20:49:15
> Hi Paul,
>
> When you took Valium initially, before you did the slow taper, what was the maximum dose that you took??
>
> Btw, are you on any other medication at the moment?
>
> >Burning skin, paranoia, dizziness, world looks surreal, mild tremor, insomnia, agitation, stange sinking sensations when I take steps, weakness, zero apetite.
> >37.5 mgs Valium.
>
> Did you have all these symptoms when you were on 40mg?
>
> >....to walk with a cane, to "adapt to it" like a quadaplegic does.
>
> I wouldn't ever say that to you.
>
> RE what can I do to get well???
>
> One option would be to withdraw the diazepam and have flumazenil infusions in a hospital clinic.........
>
> Please read my post (and the rest of the thread)............
>
> http://www.dr-bob.org/babble/wdrawl/20050228/msgs/473333.html
>
> 'Flumazenil (FLU).....significantly reduced withdrawal symptoms in comparison with oxazepam (a benzo) and placebo on both self-reported and observer-rated withdrawal scales. FLU also reduced craving scores during the detoxification procedure. In addition, during oxazepam tapering, group B patients experienced paradoxical symptoms (which may be what YOU are experiencing Paul) that were not apparent in flumazenil patients. Patients treated with flumazenil showed a significantly lower relapse rates on days 15, 23 and 30 after the detoxification week. Our data provide further evidence of FLUs ability to counteract BZD effects, control benzodiazepine (BZD) withdrawal and normalize BZD receptor function. The effectiveness of FLU may reflect its capacity to upregulate BZD receptors and to reverse the uncoupling between the recognition sites of BZD and GABA, on the GABA(A) macromolecular complex, that has been reported in tolerant subjects.'
>
> 'Flumazenil has also been proposed as a treatment for protracted benzodiazepine withdrawal, where neurological symptoms persist long after the drug is discontinued. It is thought that flumazenil might be able 'reset' benzodiazepine receptor function.'
>
> Kind regards,
> Ed.The 40 mgs worked pretty good for about 6 weeks Ed, still had some symptoms but was functional, then it pooped out. I then decided to taper off and it got worse. "Paradoxical", I do not know. Just quit working. The other detox method you speak of is cutting edge, doubtful I could get in in the U.S., even with insurance, which I do not have. Best I would get is phenobarb or librium for a few days then forced into AA meetings all day, instructed to "calm down" by lower level nurses when withdrawals hit, perhaps labled psychotic if the wild stuff hit and it probably would, then shown the door after 30 days. In a word, I am screwed. Only other options would involve increasing the Valium dose or crossing over to Klonopin.
Posted by Paul Smith on June 18, 2005, at 22:55:53
In reply to Re: Valium help, I cannot taper » Paul Smith, posted by SLS on June 18, 2005, at 21:43:05
> Hi.
>
> > I live in symptoms, they do not disappear.
>
> Please correct me if I'm wrong, but you are saying that there is no dosage of Valium that will allow these symptoms to disappear?
>
>
> - ScottI do not know Scott, Am way high now, going back to 40 mgs. How high does one want to go with this drug? 50, 60, 80 mgs? Then if it poops out there you are all the more screwed. On a recent trip to Central American they were shocked to hear I was on 40 mgs a day. Their health ministry only allows prescribling 30 of V a day, 2 mgs of K.
Posted by SLS on June 19, 2005, at 9:55:50
In reply to Re: Valium help, I cannot taper, posted by Paul Smith on June 18, 2005, at 22:55:53
> > Hi.
> >
> > > I live in symptoms, they do not disappear.
> >
> > Please correct me if I'm wrong, but you are saying that there is no dosage of Valium that will allow these symptoms to disappear?
> >
> >
> > - Scott
>
> I do not know Scott, Am way high now, going back to 40 mgs. How high does one want to go with this drug? 50, 60, 80 mgs? Then if it poops out there you are all the more screwed. On a recent trip to Central American they were shocked to hear I was on 40 mgs a day. Their health ministry only allows prescribling 30 of V a day, 2 mgs of K.
I hope I haven't sounded condescending by asking you these questions. I was just trying to get an idea as to whether you could accomplish a BZD discontinuation the same way I have with Klonopin and Ativan. I used a flexible-dosing method that I found very effective, but I began the taper from a dosage that produced no withdrawal symptoms.Sorry about the additional question, but I am still unclear as to whether there is a lowest dosage at which withdrawal symptoms disappear, regardless as to the degree of tolerance you have developed to its therapeutic effect. You said that you live in a chronic state of withdrawal. Would this be true if you were to increase the dosage? At 40mg, can you remain without the occurence of a withdrawal syndrome indefinitely?
If I were in your position, which I'm sure I cannot fully appreciate, I think I would want to increase the dosage to whatever is the minimum that would prevent a withdrawal syndrome from occuring until you have a new strategy in place for discontinuation. Of course, if continual dosage escalation is necessary just to prevent the symptoms you describe, this is not a viable option.
I personally think it is a bad idea to allow the brain to be subject to extended periods of unmitigated BZD withdrawal syndromes. I currently believe that there is a chance that allowing this to occur acts to kindle and sensitize the brain such that the syndrome worsens in intensity, becomes more refractory to symptomless discontinuation, and persists longer after discontinuation is accomplished.
I'm just thinking out loud. This might all be worthless conjecture.
Ed's suggestion of using flumazenil sounds interesting. I would have expected that such a drug would worsen withdrawal in much the same way naltrexone or naloxone makes worse withdrawal from opioids. I imagine there is much about the properties of flumazenil I am unaware of.
So much for my ability to understand things...
Has it ever been suggested to you that you use an anticonvulsant to reduce the intensity of withdrawal symptoms?
I wish you nothing but luck on your endeavor to discontinue BZDs. I hope you continue to post here.
- Scott
Posted by ed_uk on June 19, 2005, at 11:46:18
In reply to Re: Flumazenil: an option for Paul???, posted by Paul Smith on June 18, 2005, at 22:50:54
Hi Paul,
Have you ever used an anticonvulsant to help you withdraw? Some people have had success with Tegretol.
~Ed
Posted by Paul Smith on June 20, 2005, at 20:38:51
In reply to Re: Flumazenil: an option for Paul??? » Paul Smith, posted by ed_uk on June 19, 2005, at 11:46:18
> Hi Paul,
>
> Have you ever used an anticonvulsant to help you withdraw? Some people have had success with Tegretol.
>
> ~EdNo i see my counselor thurs, if i last until then then I will probably be pleading for mercy at the hospital. There are magic words you can say where they have to keep you 3 days minimum even if you do not have insurance, which will do little good but it is something. I cannot taper this drug again and increasing the dose I think would make me sicker. I can hardly eat now.
Posted by ed_uk on June 21, 2005, at 10:22:15
In reply to Re: Flumazenil: an option for Paul???, posted by Paul Smith on June 20, 2005, at 20:38:51
Hi Paul,
When you took diazepam the first time around, before you tapered, did you ever take as much as 40mg?
Do you take the diazepam as a single daily dose or in divided doses? Perhaps you could try taking 10mg four times a day to minimise fluctuations in your blood level - which might lead to withdrawal symptoms.
Apart from diazepam, are you on any other medication at the moment? Even if you can't withdraw, treatment with an anticonvulsant such as Tegretol or Neurontin might be effective in relieving some of your symptoms. I think you need to be evaluated by a neurologist if at all possible.
Here is my *theory*..........
Your brain has adapted to the presence of diazepam .........but the adaptations are in excess of what would have been necessary to 'cancel out' the anxiolytic/sedative effect of diazepam. As a result, you are experiencing 'withdrawal symptoms' despite the fact that you're on a high dose of diazepam.
I came up with this theory because of what can occasionally happen with other drugs of dependence eg. opioids..........
For example, opioid analgesics are used to treat severe pain. In the long term, tolerance to the pain-relieving properties of opioids develops in some patients (but not others). Increasing the dose is usually effective in restoring the effectiveness of opioids. However, a few patients develop 'paradoxical' pain when the dose in increased. It is thought that the brain's adaptations to the opioid may in some cases exceed that which would have been necessary to simply reverse the pain-relieving properties of the opioid. As a result, the pain gets worse despite the fact that the dose has been increased - this phenomenon is known as hyperalgesia.
RE opioids.........
'One consequence of repeated drug administration is the development of adaptations in the nervous system, sometimes termed 'drug-opposite' responses. During administration, the effects of the drug are diminished by these adaptations (tolerance), while cessation of drug use results in the emergence of these drug-opposite responses as the withdrawal syndrome..............While opioids.......produce analgesia, people with a history of opioid self-administration are hypersensitive to certain kinds of pain during the time they are under the influence of the analgesic drug. This suggests that in pain systems, the drug-opposite response exceeds the pain inhibiting effect of the drug itself. This hyperalgesia is evident in people with a history of heroin use and is not modified by methadone or buprenorphine treatment but is reduced by long-term abstinence from opioids. This same pattern of the drug-opposite response exceeding the drug effect may also occur for mood. While opioids cause elevation of mood, commonly described as euphoria and reduction of emotional distress, methadone maintenance participants show significant negative mood disturbance relative to controls. Thus, for pain and mood, the chronic opioid user under the influence of the drug does not experience an opioid effect diminished by tolerance but a state opposite to the effect of the drug.'
I suggested flumazenil (for you) because it might be able to 'reset' your benzodiazepine receptors and 'normalise' the function of your nervous system. I wonder whether there are any clinical trials of flumazenil (for benzo withdrawal) that you could join?
If you were able to withdraw from diazepam and obtain treatment with flumazenil, protracted withdrawal symptoms might be treated/prevented by flumazenil, allowing you to recover.
Other options........
When opioids produce hyperalgesia, switching to a different opioid in often effective in restoring pain relief. Since flumazenil treatment would be very difficult to obtain, trying a range of different benzodiazepines seems like a reasonable option. I know you've already tried clonazepam but didn't like it. Perhaps could try a different benzo.
>There are magic words you can say where they have to keep you 3 days minimum even if you do not have insurance, which will do little good but it is something.
I think you should ask to swap to a different benzo while you're in hospital. What about Xanax XR? If you don't want to switch, perhaps it would be best to return to 40mg diazepam eg. 10mg four times a day.
Kind regards,
Ed.
Posted by ed_uk on June 21, 2005, at 10:42:42
In reply to Re: Flumazenil: an option for Paul???, posted by Paul Smith on June 20, 2005, at 20:38:51
PS.
Paul, are you still taking Paxil for anxiety? I think you said it was helping. Have you recently stopped taking it?
~Ed
Posted by ed_uk on June 21, 2005, at 10:47:48
In reply to Re: Flumazenil: an option for Paul???, posted by Paul Smith on June 18, 2005, at 22:50:54
>Ed, still had some symptoms but was functional, then it pooped out.
When you say that it pooped out, do you mean that your anxiety returned or that all your withdrawal symptoms returned??? eg. burning skin, paranoia, derealization etc.
~Ed
Posted by ed_uk on June 21, 2005, at 10:54:41
In reply to Valium help, I cannot taper, posted by Paul Smith on June 15, 2005, at 17:00:10
>an idiot doc put me on Xanax........
Ahh right, you took Xanax initially, not Valium. What dose did you take?
Perhaps you could try Xanax XR instead of Valium. Xanax XR rarely lasts all day, but it might be an improvment on regular Xanax. You could try taking Xanax XR in divided doses eg. every 6hrs, every 8hrs or every 12hrs. If you do go to the hospital, perhaps they would let you have Xanax.
Some people have complained that Valium is not very effective in treating Xanax's withdrawal symptoms. Perhaps you'd be better off returning to Xanax. I suggested Xanax XR because it has a longer duration of action than regular Xanax. What do you think? I know Xanax XR is expensive but it's quite a lot more convenient than normal Xanax. If you took normal Xanax, you might need to take a dose every few hours.
~Ed
Posted by ed_uk on June 21, 2005, at 11:32:26
In reply to Re: Valium help, I cannot taper, posted by Paul Smith on June 18, 2005, at 18:04:32
>Burning skin, paranoia, dizziness, world looks surreal, mild tremor, insomnia, agitation, stange sinking sensations when I take steps, weakness, zero apetite.
Did you have any of these symptoms when you were on Xanax? (before you tapered)
If not, perhaps you could 'cross taper' from Valium to Xanax XR - gradually reducing your Valium dose as you increase the Xanax XR. I don't think it would be wise to switch from Valium to Xanax XR overnight.
~Ed
Posted by Phillipa on June 21, 2005, at 17:56:10
In reply to Re: Valium help, I cannot taper » Paul Smith, posted by ed_uk on June 21, 2005, at 11:32:26
Ed, what is this new disolvable xanax? My pdoc asked if I wanted to try it. She said put in mouth and it dissolves. And I wasn't asking her for another benzo. Maybe she doesn't think I'm depressed. Or is she pushing a new form of benzo? Fondly, PJ O
Posted by ed_uk on June 21, 2005, at 20:06:45
In reply to Re: Valium help, I cannot taper » ed_uk, posted by Phillipa on June 21, 2005, at 17:56:10
Hi PJ!
>Ed, what is this new disolvable xanax?
It's just a new and expensive formulation of alprazolam. I expect your pdoc thought it would be good for panic attacks.
Ed xxx
Posted by reefer on June 27, 2005, at 17:01:37
In reply to Re: Flumazenil: an option for Paul???, posted by Paul Smith on June 18, 2005, at 22:50:54
If i was in your place i wouldn't consider withdrawing an option. I would move to a high potency, long acting benzodiazepine like Klonopin. If you are on around 40 mg's of Diazepam move to 2 mg's of Clonazepam per day. Then >increase< to the lowest possible dose you feel ok on. You will probably feel comfortable on between 2 - 4 mg's day. And if needed due to tolerance buildup don't get paranoid. Increase the dose. You will probably roof at around 6 - 8 mg's. This is a normal dose for people with epilepsy. I wish you luck!
As for myself i've been tapering for a few months and i'm down to 0.25mg's of Clonazepam daily now. And it's really really hard now. Even the smallest cut makes me wanna bang my head against the wall. Luckily i discovered buprenorphine. It really helps the anxiety and lifts the depression associated with the benzo withdrawal. I know i'm not having nearly as bad withdrawals as you are having, it's not my point. My point is that i'm feeling okay with the w/d's if i wouldn't i would just stay at the benzo dose i was comfortable with and that's what i think you should do.
This is the end of the thread.
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