Mark Horowitz, MBBS, PhD // Safer Tapering of Psychotropic Medications
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- čas přidán 22. 01. 2024
- #deprescribing #benzowithdrawal #psychiatry
To order the Maudsley Deprescribing Guidelines: amzn.to/48XaG9m
I am a training psychiatrist, having done part of my training in Australia and now working in London as a Clinical Research Fellow in the NHS and an Honorary Clinical Research Fellow at UCL. I have also completed a PhD in the neurobiology of depression and the pharmacology of antidepressants at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London. During my PhD I received two prizes from the British Association of Psychopharmacology, one for my PhD work - for which I was invited to give the Hannah Steinberg lecture at their summer conference - and one for public communication.
At the same time as researching the way in which antidepressants worked I have also been taking this medication since I was a medical student. It was not until 15 years later that I tried to come off this medication as I wondered whether it was responsible for the fatigue which had led to me being diagnosed with the sleep disorder, narcolepsy. When I tried to come off this antidepressant over 4 months I received a very abrupt education into antidepressant withdrawal symptoms. I experienced insomnia, panic attacks, dizziness, anxiety and low mood. This was nothing like the Woody Allen-level neurosis that had led me to start them in the first place - and I had experienced nothing like it before.
It was also something that I had not been taught about at medical school or in psychiatry training. I soon learnt by reading the academic literature available that the psychiatrists and academics at the institution I had studied at and others like them around the world had little helpful to say about withdrawal effects from antidepressants - they recommended stopping the drugs over 2 to 4 weeks, and reported that the symptoms were mild and brief. Many prominent academics with close ties to pharmaceutical companies attacked academics and patients who complained of trouble coming off their antidepressants, accusing them of malingering, or seeking legal payments.
Instead, the place where I found the most useful advice was online peer-support websites (especially Surviving Antidepressants) filled with people trying to come off their antidepressants. There I found people describing the exact same symptoms I had experienced: like me, their symptoms were neither mild, nor brief. And this was not a handful of people - instead I found tens of thousands of people with near identical complaints. None seemed to be malingerers, in it for a buck or ignorant - they all had been told by doctors that there would be no major issue in coming off their medication and all had been given unhelpful advice by their doctors to come off in just a few weeks.
Even more helpfully for me, these online groups described a better way to come off antidepressants: going down by small amounts, that become smaller and smaller as the total dose got lower, and going down to very tiny amounts before completely stopping. I am using this method to come off the antidepressant I have been on for so many years, as well as the other psychiatric drugs I ended up being prescribed, in what I now see as a prescribing cascade, where adverse effects led to more medications. Reducing my medication has greatly improved the tiredness, problems with memory and concentration that have plagued me for years (and for which I was given psychiatric and neurological explanations).
I wrote a paper about how to come off antidepressants based on the neurobiology of their actions that was published in The Lancet Psychiatry and widely reported. Since then I try to communicate to psychiatrists, other doctors and the public how to safely taper off antidepressants and other psychiatric medications. In realising that I had been misled on how difficult it is to stop psychiatric medications, I have been forced to re-evaluate other information I have taken for granted about psychiatric medications, how they work, what they are treating and what their long-term effects might be.
Dr. Horowitz’s website: markhorowitz.org/
The serotonin theory of depression: a systematic umbrella review of the evidence: markhorowitz.org/academic-pap...
Tapering of SSRI treatment to mitigate withdrawal symptoms: markhorowitz.org/wp-content/u...
A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse: markhorowitz.org/wp-content/u...
Dr H is really my favorite source for good information on tapering. The one key thing I learned from him is that the effects of any change you make to dosing can take many weeks and even over a month to fully show the results. It made me realize that I just haven't been giving changes long enough to really know whether it was the best move or not. It took about 5 weeks for me to become stabilized, start sleeping and get more functional after I made a change. I almost threw in the towel. It's a big lesson I keep in mind now with any change I make to tapering. In the past, if it didn't have a good effect within a few days I would think it was the wrong move. Important lesson.
And according to the Eli Lilly researcher I spoke with about all this in 1993 that is because of the high rate of accumulation of these drugs in brain tissue. The accumulation rate was shocking to even him! And it would help Robin Williams wife in her research into understaanding more about the Lewy Bodies connection to Robin's suicide brought on by the REM Sleep Disorder produced by these drugs & their 98% protein binding aspects.
Interesting, since most loath the thought of holding. Glad it’s helping. Have you continued tapering at a slower rate or are you still holding?
@@TE-7302- I'm tapering at a much lower rate (like 2% every 2-4 weeks) and able to work and sleep still, thankfully. It will be a long road but I need to function.
@@DrAnnBlakeTracy did she say how long it remains in the brain tissue? Thankyou 🙏
@@lisam2036 what milligram are you on to where you’re needing to take it at 2%? I’m curious I’m at 75 mg of Effexor right now and I took out 13 beads
Thank you so much, Angie and Mark. As I'm tapering off Paxil and a Moderator of a support group, it's so refreshing to hear Mark say, "I don't know." So many times people are looking to us for answers...I try and help them, often, "I don't know."
I wish he had influence over the prescribing that happens in the Maudsley psychiatric hospital.
I have a close friend who was in there and they are very over medicated in there with psychiatrists telling patients their side affects aren’t real :/
This video is so good !! I have a 50 minute zoom meeting with Mark in 10 days. So good to find a qualified Dr who has actually been through this torturous journey ❤
How did you get in contact with Dr Horowitz?
@@anadecim if you google him, you'll find his website, then click on contact him ♥️
And how did it go?
@@hey956 it was great !!!
I’m so happy for you! I didn’t know that was possible! WONDERFUL! I was fortunate to have been given access to his company’s library by the co-founder in Toronto, Canada, though I’m in the US. I’m coming off a different category & it’s taken me 4 years to get half way off. I have to hold my dose till I find affordable housing, as my rent is now 97% of my income. I noticed a lot of stress makes recovery much harder, as the nervous system can’t seem to deal with it & then the memory & focus I’d gained, I’d lost due to this. It’s seems surely a marathon & not a sprint! All the Very Best to You!
Thank you both for this great video!
Dr Horowitz's findings and research regarding tapering off psychotropic drugs are extremely valuable! and his expertise as well as his commitment to help people taper off medication safely and responsibly should be praised.
👌🏼
Angie.... Thank you for this excellent interview.
I am challenging everyone I know in this community to "gift" their provider with the Maudsley Deprescribing Guidelines. I've read the Kindle version and it is fantastic and exactly what we have been waiting for to present to providers!
Thank you. I have never heard of it even though I bave been assisting patients in SSRI withdrawal & warning about it longer than anyone I know - about 30nyears now.
It was so shocking & exciting to learn that in western Massachusetts, US, some EMTs are learning about his clinic! GREAT NEWS! I so love seeing him explain the hyperbolic curve, etc.. There aren’t words to express my gratitude to you, both! I loved this & look forward to receiving my his book! 🙏🏼🙌🏼
1027days off now
Congrats. Did you experience insomnia? How long till you felt better?
Everyone experiences insomnia in withdrawal from these drugs because they inhibit the metabolism (reuptake) of serotonin. Melatonin, which helps you to sleep, is made by serotonin being metabolized into melatonin. After inhibiting that metabolism for many years by the use of these antidepressants, that ability has to be rebuilt. I have helped people in withdrawal from antidepressants since 1992 & recommend many alternative treatments but especially a good digestive enzyme & probiotic along with aromatherapy treatment for direct access to the brain.
How much you cut each time my son on 10mg clonazepam,tks
It was so helpful to hear his personal experience. I knew about the SSRI, but not with as much detail. It makes such an impact to hear personal stories. Love the analogies!
Looking great angie. Also thank you for keeping making videoes. We appriciate everything you do. Have a speedy recovery everyone.
We should all receive flowers along with a thoughtful sympathy card wishing a speedy recovery. Wouldn't it be nice.....:)
Thank you so much for your work Mark, and for publishing the deprescribing guidelines. It will make such a difference for patients to have this resource to take to their doctor, and for personal guidance as they taper off the meds. Thank you also for the personal note of encouragement and hope at the end of this interview. My daughter has been withdrawing from prescribed medication for over three years now, and still has times of intense suffering. It's always so good to hear the stories of recovery. Thank you Angie for another great interview ❤
Nice interview. I'm glad we were reminded that it's still very much an ongoing learning experience for everyone involved - there are as yet no easy and definitive ways for recovery, but more and more is being understood over time, for better outcomes. Regarding the definition of akathisia, I feel that the word "pacing" is overused, since I think a lot of sufferers don't necessarily pace outright. Some people with akathisia can look pretty normal on the outside, but be experiencing extreme agitation internally. I wonder if the definition "relentless inner terror" makes sense?
Inner terror and agitation I can relate to that!
Oh i have this feeling now ...since my last reduction
433 days off clonaz, 3mg Zoloft to go 🎉
Mark is the best! Great interview. Can’t wait for Maudsley’s
Pls just my son on 10mg clonaz how slow tapering you did pls reply tks
@@kalaiselviramaiah385410mg? Is that accurate? I was on 0.5mg. Generally you can reduce by 5-10% of the current dose every 2-4 weeks. Start very slow. If he has only been on for a short time, he may be able to move a bit faster.
Make sure you wait several weeks between reductions. It takes a while to feel the cut, especially if he’s been taking it daily
@@kalaiselviramaiah3854Check out the Ashton Manual, it tells how to taper off benzos and antidepressants.
Yay Angie!! Couldn’t wait to see this interview. Two of my favourite GOATs. ❤
this third possibility that the withdrawal attempt i made 3 weeks ago was great until i developed a pretty severe reaction to taking baths. Every pore stings and burns and then turns bright red. I know now that i made too big of a cut by halving usual dose of effexor but the improvement in mental clarity and attention was immediate. On a higher dose the mental symptoms were worse. As i creep towards microdosing the symptoms are mainly physical. This video was perfect ❤
This is me at the moment. 27 years on 20mg Paroxetine. A few times trying to get off each time worse than the prior time.. This latest time I got down to 10mg too quickly then a GP told me to miss doses which I did for two weeks. I ended up in hospital with serious hypertensive crisis x 2 which we now think is related to me being high risk on the withdrawal scale. When I got home I panicked as severe chemical anxiety and mild Akathasia had kicked in as well as debilitating physical symptoms. I updosed to 20mg. Big mistake however I have been helped by SA peer group who think I prob need to hold as the symptoms started before updosing. It has brought me to my knees. I am 8 weeks holding and there are a few windows but am still suffering intensely and feel I may never get better. My husband has taken data on this recent withdrawal episode which has been very helpful for us to work out what has been going on I am so grateful for Mark Horowitz, Angie and SA. I have already sent details of this book to my GP here in Australia who will probably roll his eyes. 🙏
How did you find a peer group? Is it online? Tia
@@mazymonroe8749 Hi, yes it’s online. It’s called Surviving Antidepressants and it’s been a lifesaver…
I just hate that feeling like you’re in “no man’s land” suffering with withdrawal, panic, depression. Just trying to make it. I find it hard to believe what anyone tells you when you’re in this emotional hell, space!
A GP suggested to me recently i skip my benzo on alternate days to taper ...lucky 4 me i knew he was very very wrong to say that !! I am halfway in my taper, years into it and now very sick, lowest of lows 😢😢😢 cant see a way off. Updose or hold ? God help us all.
@@mazymonroe8749 gosh sorry I have only just seen this. ‘Surviving Antidepressants’ online group.
THIS is the best video I have ever watched on Benzo withdrawals and I can’t wait for his book. Thank you Angie!!!!
My pleasure!
New to your channel. Commenting for the connection. I appreciate the optimistic attitude. Thanks.
I am almost 69 years old. I have been tapering almost two years. I am .75 percent on Lorazepam. One month I will taper tiny bits, it will take me six months to get off of this medication. I am tapering slow and easy. I live alone and I have severe osteoporosis, so I am afraid to fall like I did last time, and I broke three bones.
God Bless you, I hope you are doing well!
I found the comment re: tolerance happening in the 4 weeks interesting as I used Paroxatine for 23 years and only noticed tolerance related side effects - sudden mood episodes, muscle issues and pain, eye pain, inability to focus and digestive problems in the last 2 years. It took me way too long to understand that these problems were all due to the drug I was on and not one doctor I saw over that period ever thought to mention the possibility.
Did you manage to get off paroxetine?
After a way too short taper of 5 weeks, I managed to last 5 months before crippling waves of depression, intrusive thoughts, insomnia and muscle spasms had me reinstating with a new SSRI in the new year. I felt so close to losing myself forever, and having my daughter and new baby living with us made the situation impossible. I still have withdrawal symptoms from the original medication plus some new ones, but at least I have ‘me’ back. FYI I never experienced depression before taking an SSRI, which was prescribed for panic attacks. @@danielowens5360
Reinstatement helped me alot i went from 50-25mg Trazodone and got horrible withdrawl so i went back to 37.5 and helped alot i think. Still need to stabalize completely but going to go way slower when i drop again.
Thank you both so much, Angie, and Mark. I so wish I had access to the book you've written Mark, when I first started my taper. So glad it will be there from now on for prescribers and people seeking to safely taper. I was lucky to find the Ashton Manual via Benzo buddies, but it turned out that the last steps were too quick for me. thank you both for your contributions in all ways.
Yes the Ashton manuel is too rapid a withdrawal for these drugs. Which benzo were you on?
@@DrAnnBlakeTracy Hi Ann, I was on a relatively low dose of Diazepam (valium) for 18 months, however it was prescribed to me (to supposedly mitigate) the devastating effects (Serotonin Syndrome and akathisia) from 6 weeks on an SSRI (Sertraline) and prn Quetiapine (which i hardly took because of it's paradoxical effects). That medical event left me with clear neurological damage - movement disorder, tics etc and ongoing akathisia. I never sought to take any of these medications; on the contrary I was described as 'resistant'; in the end I complied so as to not get 'off-side' with treatment providers who were supposedly providing care in the aftermath of a traumatic, violent crime. I was promised I would only have to take the benzo for 'a short time' and with 'overview of withdrawal' but instead I sought and failed for the oversight continously until I eventually took matters into my own hands and came off without access to the necessary information about safe tapers. I did have 'medical oversight' but it was from a Psychiatrist who clearly knew Nothing about deprescribing, and who gaslit me with claiming my withdrawal symptoms were from the original traumatic crime event (!). It was really appalling imo that I kept asking the prescriber why he wouldn't oversee a benzo taper when I was gaining no benefit from the benzos and had bothersome side effects, and the response was always something that suggested that I would be far worse 'off' them. It's really appalling that they sought to sedate and stupefy me instead of allowing me to deal with and process what had happened, in my right mind. It wasn't until I came off the benzos that I realised the extent to which they were responsible for mainy symptoms that I'd attributed to the TBI head injury from the crime e.g. memory loss, confusion etc. And most of all that they had aggravated akathisia, which has largely stopped since I completed my withdrawal. Thanks for your question. apologies for long reply.
@@DrAnnBlakeTracy ps. Thank you so much for your work and your writing.
@@DrAnnBlakeTracy Hi Ann. I was on a relatively low dose of Diazepam (valium) for 18 months. It was prescribed in the aftermath of severe Serotonin Syndrome and Akathisia after 6 weeks on an SSRI (Sertraline) which had been prescribed off-label, and (rarely used) prn Quetiapine. Once the Sertotnin Syndrome was identified, I was allowed to stop taking it but it left me with clear neurological damage including a movement disorder, and verbal tics (which persist). I was prescribed Diazepam to supposedly mitigate the 'side effects' of withdrawal from the Sertraline. The Sertraline had originally been prescribed off-label in relation to an horrific, violent crime that had left me with injuries including a Traumatic Brain Injury.
However The treatment providers always managed to muddy my iatrogenic injuries with injuries from the crime trauma. I never sought medication for anything, and was described as 'resistant' to it. I only agreed to take the Sertraline after many months of coercison, for fear of getting off-side with professionals at a time when I was in need of help and support. I have paid so heavily for that compliance. It bothers me that they sought to sedate and stupefy me instead of allow me to process what I was dealing with, and to recover. Anyhow, I'm glad to be at this end of it. The original crime trauma was 6 years ago. I have been meds free for 4 years.
Yes, the tail end of the ashton manual was far too abrupt. I had got down to 1 mg over many months and then I jumped down to 0.5mg and the proverbial hit the fan - depersonalisation, derealisation, sudden onset agarophobia, social phobia etc and a parlysing chronic fatigue which persists.
At that stage, I slowed down the taper and I found ways to get liquid diazepam and then completed a hyperbolic taper over the next 12 weeks for the last .05mg. I was trying to do things properly and cautiously but I found it so difficult to access helpful, reliable information until it was 'too late'.
Thank you so much for all you have done in this space. So much appreciated.
Yay to both! 🫂💎🦋🥰🌷🇨🇦🙋🏻♀️
Thank you for your great helpful information.
Congratulations Angie & Dr. H on ALL you’ve accomplished! I don’t know how you 2 are functioning as well as you are! It’s great to see people who are able to work & still have purpose! I’m so grateful for you both.
(This is certainly a marathon & not a sprint.)
My copy is on its way, thanks to a very generous friend! 💎🙏🏼 Much gratitude & great respect to you, both. 🙌🏼🙌🏼🙌🏼
(I’ve spoken to you, Angie in the Q & A part of Medicating Normal online in 2020 & have access to Dr. H’s content in Canada via his co-founder. I’m only half off, took 4 yrs, now my APRN/NP doesn’t believe me regarding symptoms & I’m so grateful for you both! I hope I will get to meet you, both...Angie, again & Dr. H. I cannot thank you, both, enough.
Great interview as always! I am about to start my taper. Mark suggested I hold u til at least January! Wish me luck I am petrified!!
I would love to be a healing coach. I'm a psychiatric survivor too.
Best interview yet! Thanks so much, Angie. I just preordered his deprescribing guidelines book. 👍🏼👍🏼
I was kindled 7 times and now I’m stuck in severe pain from benzos
I have at least 8 withdrawals / kindles and then several surgeries and injections that involved Benzo’s on top of that. My wd was extra severe because of it. Please hang in there. We heal!
@@AngiePeacockMSW the k you for responding
@@AngiePeacockMSWplease please help me. Should someone reinstate if a single dose triggered severe withdrawl hours after taking it?
I cant do this anymore, what should i do please?
I’d very much like to see Mark Horowitz at a Stahl NEI Conference for a deprescribing plenary session and selling the Maudsley book along with the Stahl Prescribers Guide. We have to be receptive to this as prescribers. Thank you!
Such an excellent interview. Thank you so much, Angie and Mark. I will watch/listen to this again. There are so many teaching moments. And the hope throughout this interview, but particularly at the end, was beyond priceless.❤❤
47:08 insightful , first most tolerance happens in first four weeks most ..
Thanks so much for this? I needed this type of interviews, I’ve been holding for 2 months after being off and on different meds just destabilizing my nervous system. Thanks Angie ❤
Enjoyed this 🎉thank you so much ❤
Excellent, thank you both ❤
Excellent! Thank you.
love your glow, angie,.... both of your glows!
nice talk..u both doin great work..
This was incredible! ThanK you both for your wisdom, hard work and vulnerability. What beautiful humans you are ❤❤
I would like to see the graph on a log-linear scale. I think it can help to communicate the hyperbolic taper visually.
Fast taper 13 years of zoloft use. Can you reinstate after 7 months or is it too late when you’ve crashed into severe WD? Can akathisia get worse if you reinstate? Pls answer…
Enjoyed the video, thank you. Our only complaint is there was no mention of antipsychotic drugs. It's been a nightmare on our end and finding help, in terms of a slow taper, has been unsuccessful in our town. We were hoping to hear something, anything, regarding antipsychotic drugs. We totally feel alone in trying to help our loved one. We are trying to learn by going on the internet, watching videos, reading blogs, purchasing books, joining groups, and we ask a lot of questions. However, it feels like every which way we turn, there's a wall, we are let down often and, unfortunately, hopelessness start sinking in again.
Check out Will Hull. He’s done a bunch of research on antipsychotic deprescribing ❤
Agree. It would be great if there was a future version that included antipsychotics and mood stabilizers.
@@kmkeenanHe did mention, on a different platform, he is or will be working on an antipsychotic taper guide. I am not sure when that will come out- I believe he stated it may come out in 2025. It would be helpful if we could get taper updates with every med that has been studied instead of waiting for the whole guide/ book to be completed. People who are suffering may lose hope by the time we get any kind of information.
@@kata6966 That's good to hear. I hope someone will do work on mood stabilizers as well. When I was tapering lithium, I didn't find a lot of useful resources. Also, I believe lamictal could use more attention.
To me they’re all very similar. In my tapering support circles, you can’t tell what drug people are tapering unless they tell you because all the symptoms are similar. A slow hyperbolic taper- patient led- for ALL classes of psychotropic drugs seems to be the answer for most of us.
Before this, I only had the digital version, but when Mark was like "the book doesn't come from the internet" and I remembered myself in the ER, while the swat team was outside the door asking if they needed to like press the red button to get the large veteran man outta there, and how much easier it would have been if I handed the psychiatrist the guideline book. Now I just ordered the hard copy so that shit's with me all the time I've been in Canada for 6 years and have not gotten my healthcare setup because I was horrified of the universal rules, among other things. I feel comfortable, confident and most of all, my wife and I no longer feel alone.
Even though it’s not a benzo but very gabaergic, there’s not much discourse on Xyrem and it rly it f’d me up. Thx for bringing it up
Oh no! Not another one! What is Xyrem? They pump them out so fast I cannot keep up! What are they using that one for? Is it serotonergic too?
@@DrAnnBlakeTracy hi doc. It’s literally a prescription version of the date rape drug/street drug called ghb. It hits the gaba-b,ghb, serotonin, and dopamine receptors. It’s given to people who have a hypersomnia or narcolepsy diagnosis, and puts you in a deep coma like sleep state at night where you blink then hours have passed . Idk what I was thinking taking a chemical sledgehammer to my brain every night.. but I paid for it because I developed all the symptoms that people get when they have severe protracted withdrawals from traditional benzos. Just now getting windows at 2.5 years off lmao.
Great interview! Tapering off 1.25mg of K..
God work Angie 💜
1:05 you get back to yourself.. you can get their by crawling
Yes! This comment is what many probably need to hear.
I want to get my hands on this book!
amzn.to/4bfTcam
@@AngiePeacockMSW thank you 😊
I was on terrible state after 7 week of cymbalta,then benzoz,hit tolerance in 4 months,30mg to 75mg oxaz.tapered 10 months now,everyday is worse,can't hold,so much toxicity,just have to taper,even microtapering with water not ease these symptoms.tons of symptoms,every day 24/7.
Chronic fatigue set in 3 years ago, I’m a 71 female
3 variables that I ponder -what stole my life with chronic fatigue?
-Started the wean from klonopin 2mg 2021 to currently 0 .5mg (30 year band aid to control my panic attacks)
-Got my 4th Moderna vaccine in 2021
-My Hashimotos hypothyroidism resisted medication management since 2021. June 10, 2024 finally getting TSH in balance.
(History of traumatic abuse from both parents that I buried until my brain surgery in 2018 triggered PTSD. Weaned off Wellbutrin in 2019 post 30 years taking)
The 0 .5mg titration in April 2024 from 0.75mg has been the most brutal drop.
CAN A 71 year old successfully wean off klonopin?
So much important information here to help me make decisions about my complex situation. Thankyou Mark Horowitz and Angie.
I would like to hear more about sensitisation. Angie I would love to know from you and others who have come through the hell of withdrawal about what happens when big stress events happen in your life. How does a sensitised nervous system get on once through withdrawal. I ask this because at 25 mg of Zoloft I was stable for 9 months and then I had some stress that brought on a nervous system reaction bordering on Akathisia. It didn’t improve after 9 months and I was shocked and unprepared so introduced mirtazapine. Listening to this now, I probably should have stayed for six months but I didn’t know what was happening. I thought I hit a late onset withdrawal. So … moving into the future what now? After going through withdrawal after long term use ( 20 years) will I have a sensitised nervous system with all its horrible symptoms, forever ? Begs the question, is it safe to come off at all. Interested in anyone’s thoughts on this
Typo - didn’t get better after 9 weeks
This is what worries me too…
Me too, I went off to zero. Hell 7,5 months off.
Is it safe to taper Ativan and Ambien at the same time? I take 10mg Ambien nightly for over 20 years, Ativan off and on for about 15 years. Sometimes Ativan just once daily. How slow do I need to taper Ambien?? Thanks so much!!
Any experience with tappering clozapine .....I've have started with my son from 650mg down to 275mg last six months he is doing very well. Slowing titration down, currently on carnivore keto ....had taken the course offered by Dr. Georgia Ede. Would appreciate your thoughts and suggestions.
My current PCP doesnt agree on the dose equivalency of Alprazolam v Diazepam. This is making it hard for me to make the decision to crossover. She says 1mg alprazolam = 10mg diazepam. Ashton Manual says 1mg alprazolam = 20mg diazepam.
I am trying to wean off of Mirtazapine 45 mg that I have been on for 2 years for functional dyspepsia..not mental health. I was doing 10% decrease weekly and was doing fine until I got to the 15 mgs 2 weeks ago. A week later I was dizzy 2 days, then my stomach issues (gerd and burning) is back. I was trying to figure out what to do next. I only have my PCP to ask because a GI doctor prescribed this and he doesn;t have good info on weaning and really neither does my PCP. So now, I will just hold here at 15 mg to see if the symptoms resolve. Once they do, I will proceed slower, maybe 1 mg every month, if I feel ok on that dose. I like you said that it's ok to crawl. I felt like I was going to be able to get off of this faster since I was doing so well, but now I see why it got harder. I really hope I dont have to go back on a PPI for my stomach ( I was able to get off of it because of the Mirt) i have been off of it for months, but... I think a PPI might be the lesser evil between to the two drugs for long time use. any suggestions would be appreciated.
There is a really good group on Facebook for tapering Mirt. Just search Mirtazepine
@@AngiePeacockMSWI found a couple today. Thank you!
How does one know if reinstatement followed by a hyperbolic taper is the best option? A year free of 10 years on Prozac. Still all kinds of physical and cognitive issues. I don’t want to “restart the clock” per se, but I’m also desperate for some relief. My lifestyle factors are all in order as my main and only priority right now is healing.
Wondering the same about reinstating 6 months off Escitalopram?
Have you healed at all?
Honestly, if a year has passed already I personally would not risk reinstatement at this point. I have been off all meds for almost one year myself and as tempted as I am to do something, anything to try and fix my symptoms, it’s not worth the risk at this point. A few weeks or a few months, sure. But a year or more? I would strongly advise you to spend more time considering the pros and cons of that choice. There are no guarantees that it will help, but there’s a very strong possibility it could worsen things/set you back in your healing. Just don’t make any rash decisions 💜
more research needed to find out objective measures ..how we can decrease symptoms.
I’m still tapering off clonazapam, I tapered off Viibrid, but still have a lot to get off of after Clonazapam, including Soma, and Trazodone. I don’t feel any joy, just pure terror, I can’t even enjoy music, or v, plus love, I don’t know if the Chemical fear is over riding everything, but I’m scared I will never get passed this.
In my experience the fear that it is never going to end is real, understandable and I totally relate. I'm not sure if my experience will help you in any way but please know that after what felt like relentless anhedonia my ability to feel enjoyment and love is returning. We can heal. I wish the best for you ongoing in your taper.
How long did it take you to start getting some of this back? I know the anhedonia and dpdr tend to be the worst symptoms for many of us (after the a-word).
@@ashleychristie5023 Hi ashley. Anhedonia started to lift about 3 years after I completed my taper. I have been meds free for 4 years now. At first I just noticed a tiny glimmer of pleasure that started to break through like the sun peeking through a cloud. These glimmers became more frequent and lasted longer. I am still not feeling my pre-meds harm range of emotions with regards to enjoyment but I am heartened by the promise of such significant improvement. Something I have tried to focus on in my recovery from all of this drug harm is that even though the 'weather' on any given day feels pretty stormy or gloomy, the overall 'climate' is gradually improving. I think something that has been helpful for me (which fits in with what Angie and Mark say about distraction) is that I realised that I needed to divert my nervous system away from things that aggravated it. When i was able to function again somewhat, I took up a hobby (knitting) and it enabled me to focus my mind on something productive, engaging and ultimately positive and productive. I think the sensory experience of working with wool - the colour and texture was also soothing. I somehow think this was helpful, although ultimately I have learnt that it is Time that heals us. I wish you all the best.
Does anybody know if any antibiotics are better for those tapering/in WD? I get sick w strep or a UTI every couple of years and I’m assuming that will come up for me at some point, I wonder if some are worse than others or if it’s all around.
that's a question for Benzo Buddies or the FB groups.
Okay- thank you!
So the message I am getting here is if you are depressed or stressed do not under any circumstances visit a doctor and definitely not a psychiatrist!
I’m glad you deduced that from this convo!
@@AngiePeacockMSW Apologies if I seemed a bit harsh but I am amazed that Mark H has to write this manual in 2024. Have these doctors and psychiatrists learned nothing in all these years?
Thank you! Did I understand that if you taper for too long after being on the drug for a few mths could make it more difficult to come off????
Yes that is true but it may be complicated if you have prior withdrawal attempts or other history of psych drugs.
I'm wondering what the way forward is ? I didn't know this?
Thank you!
@@AngiePeacockMSW So approximately what length of time if you've taken one for 4 months?
Lex for 5mths started with 5 went to 10 then 20 for mth 5.
I had almost all of the side effects!. I started tapering in May of last year (didn't know about hyperbolic taper)went down to 2.5mg and taking alt days, that was for 3mths .
Then stayed on 2.5 to stabilize. I'm now on 2.2mgs
Slow taper for almost 5mths, since stabilizing on 2.5mgs.
I'm thinking that if I continue to come down every month by 10% to almost 0.5 its going to be long still. 🤔 thx for relying.
Unless there are side effects of drugs even when you are not withdrawing from them. They cause devastating side effects and lead to tardive dyskinesia, akathisia and catalepsy especially narcoleptics like zyprexa, olanzapine..what then?
I am Very underweight!! I would fast except I need to keep eating. I actually look anorexic as I have histimine reactions to most foods. V suppress DAO enzyme in the gut causing not being able to tolerate most foods.
Fasting is probably not for you. If you are underweight, please consult a doctor if you are thinking of fasting.
Please advise me of the name of the Dr's Book
Brian
London
It’s in the caption of the video.
When do we know that we do not need medication?
I am 56 years old, and for 30 years I have been taking psychiatric medications, and for the last 20 years I have taken a 50 mg Zoloft pill, 3 mg in the morning, and another in the evening of lixomil (bromazepam 6 mg) because I suffer from panic attacks and obsessive-compulsive disorder, and the doctor says the medicine is not harmful, even if it is taken for life.
Unfortunately, the symptoms do not go away, and whenever you reduce the medication, they come back stronger
What should I do?
First, I never tell anyone what they should or should not do. Second, if you’re still having a ton of these symptoms are your meds even “working”? Third, I don’t tell anyone what to believe or coerce them into believing what I believe about mental “illness” and medications. You have to go on your own healing journey and come to your own conclusions. Fourth, watch the film “Medicating Normal.” It’s free on Tubi or you can rent it on Amazon Prime. My story and others are in the film. It may help you think about your own story in a different way.
@@AngiePeacockMSWthis is so disheartening to read her/ his story. Because you and I both know what the reality is😢. Thank you for not scaring her and guiding her to find her own truth.
Please kindly give us advice on psychotic drugs like Clozapine.
Mark Horowitz and his team and writing the book on it right now!
I did no understand if he is off of now, or still tapering.
He’s still tapering.
When will that book be available?
Mark’s book is ready now: amzn.to/49qOq7W
What would be the right thing to do in this specific case?
I tapered the benzo slowly, it was a confortable process and after being off i felt great and reborn like i never felt through all the years on the drug.
Had still some anxiety, didnt respect the process and took "rescue doses" , each of them weeks appart, nó issues felt til one of those triggered severe withdrawl/kindling with symptoms i never had before. Woke up the next day of taking it feeling like a completely different person like a switch was off in the brain, no intentionality towards the simple actions like turning left or right, i knew something very wrong was going on but ignored it even though i couldnt do the simple things without a massive disconfort.
It kept getting worse as the weeks went by and very disturbing physical issues started.
I thought this was all caused by a single AD dose i also took that day, so 2 months after i stupidly took another benzo out of desperation. It had a calming effect but not like before, it eased things for many hours, then Boom, the severy of symptoms increased and kept increasing as the weeks went by and all my life changed, lost everything mentally and physically, its all damaged and counting, non functional in a way not similar to what its seen on withdrawl groups. People can still be in bed or do simple things to help themselves.
The second dose that triggered this misery was 7 months ago and i cant go on like this but very scared of even worse with reinstating, so i cant make myself take the pill again because of whtat happened even though i think of it every second. Is my fear rational at all? Because i dont trust my own judgment anymore.
What would be the wise thing to do given what i described? Its a tough situation and cant find no one where this happened.
Please help. Thanks
Can i get a really informed help on this please?
Hi. It would be unethical of us to give advice based on a comment on CZcams. Mark gives full consultations through his website if that's what you are interested in. I am currently full until October so I can't see any new clients at this time.
@@AngiePeacockMSW i understand.
Its not possible for me to afford a consultation as i became jobless from this. Thanks again for answering me
I came off escitalopram 25 days ago. It was not my first time on it. this past time I was on it for a couple of years. I want you to come off it. From 20 to I0 came off fast. Then, from 10mg to 0.4mg slow. As I got lower I should Have made my percentages for tappering lower. I jumped off at 0.4mg. I was fine. 5 days later, then withdrawal symptoms started waves crazy Heightened anxiety, and a couple of days later, insomnia started. I've been struggling with insomnia for some weeks now. There was a couple of nights where I got rest most nights I get nothing. I've been off for twenty-five days. I'm too scared to go back on now. Wondering how long this will last. The night anxiety palpitations and not sleeping most of all is the hardest for me. Does anyone come out the other side with barly any sleep. Thank angie for this interveiw.
No withdrawal-induced sleep issues heal as time passes.
I feel your pain, it’s such a difficult situation. I’m 11 weeks off a disastrous attempt at reinstatement - I tried 3 different ssris and trazadone over two months. Lots of trouble sleeping at 4weeks off… things were getting bad. Took an hour long Epsom salt bath every night for 3 weeks. Been getting around 5-7 hours of broken up sleep per night ever since. Epsom caused huge cortisol dumps in the morning for a few days
@@djammer I'm sorry you went through that. How long have you been completely off? 11 weeks? It's tough, I'm trying to accept. But then you have all this anxiety and fear that you have to accept also. Not knowing when things will settle.
@@KristenNicole222 yeah completely off 11 weeks. Dealing with a lot of regrets, like going on these poisons in the first place. Your main priorities right now are to get sleep and stay out of the hospital
The CES can really help restore sleep.
What do do when you did a rapid taper from benzos, did an updosed, stabilized for month and now its AS Bad as before because of tolerance?! What can I do?!
We talked about this in the video. It happens sometimes. There are many tapering in a destabilized state because they cannot get stable or hold for long periods of time.
@@AngiePeacockMSWdamn :( so i am this way the whole time to zero and month or years after that?
@@salomerummel6920 no not necessarily. You either try to hold longer (some wait 8-9 months, maybe longer) or you start slow like 1, 2, 3%. Many heal on their way down or when they get to lower doses. Some say their bodies like cutting rather than holding. Everyone is unique and you just have to try to make the best decision you can, when all decisions feel hard.
Thank you Angie. ❤ What a mess to deal with
@@salomerummel6920 many are in your position. I am so sorry.
What's the difference between a 64yr old going through the bends and a 24 yr old going through the bends. Just 40 years or something else?
Neuroplasticity may be slower, metabolism of drugs changes as we age.
Natural neurodegeneration picks up with age, and slower healing times are more common as well. The body has to work harder to heal and isn’t as efficient.
It is tougher, but far worse if you make it to 74 and have to taper for years.
Have you ever known anyone who has gotten pregnant during a taper? I’m guessing no. If yes, do you think it’s wise to hold or continue tapering at an even slower rate?
Yes I have a few people I have worked with get pregnant and carry healthy babies to full term. One even had a c section and she’s doing great and now continuing to taper.
@@AngiePeacockMSWthank you so much for replying. I think my tapering journey is going to be much longer than I originally had planned. ❤ At least I know that I’m not alone in this journey. I’m sure I’ll get pregnant sometime in my taper. I think I’ll need to HOLD whenever that happens.
@@AngiePeacockMSW I've read that the levels of escita can fluctuate and decrease during pregnancy because of changing hormones (that influence liver enzymes). Can this give withdrawal symptoms?
My situation: I have a hard time tapering so there is a change I still use a small dose while pregnant. I want to avoid withdrawal during my pregnancy so I don't want to rush the taper or jump off. But could there still be a change on withdrawal because of changing blood levels? :( Any insight?
What are z drugs? Anti- psychotics
Z-drugs are drugs that start with the letter z and are usually used for sleep. Example: Zolpidem (Ambien)
👣😳💪🏆👀👍 say 🚫🤮 to drugs
I reinstated in my 5th month off of effexor bc of too fast taper the withdrawals were unbearable. Luckily I restabilized after 3 months of reinstatement, it was brutal, I was given the option to try something else but intuitively knew I had to return to effexor.
Really? I'm terrified to reinstate after 6 months off but also feel like I'll never get off this nightmare ride if I don't
@bethgra2007 if you do reinstate as it needs to come from you. Know that you might not need to go to original dose to stabilize. I'm so sorry you are suffering. Did you taper too quickly perhaps? Doctors gave no clue except this one and a couple others.
@@MsCarmel55 I did a very fast taper after being on it 4.5 years. I didn't know anything then that I know now. I got severe akathisia immediately and still have akathisia but it's less severe.
Like the other person said if you decide to reinstate don't have to go back to the full dose you were on then stabilize before tapering any more. This could take awhile. @@bethgra2007
This is me, I’m 2 months hold and still so bad 😢