Sunday, 6 November 2011

The Tapering Process

It has been 3 months, 2 weeks, and 3 days since I took my last Benzodiazepine.  I had been prescribed 1mg of Clonazepam many years ago but it proved to be too difficult for me to taper from it, so I was crossed over to a different Benzodiazepine called Diazepam.  It had to be done in three stages.  As I introduced and increased my dose of Diazepam, I decreased my dose of Clonazepam.  Eventually I would rid completely of the Clonazepam and would begin tapering solely from Diazepam.  1mg of Clonazepam is equal to 20mgs of Diazepam.  When I crossed over, I had already made a 25% reduction of Clonazepam which left me at .75mgs.  So I then crossed over to 15mgs of Diazepam.  Once successfully crossed over, I held at the 15mgs dose for 3 weeks before I began to taper.  That allowed my body to stabilize and become accustomed to the different Benzodiazepine.

The crossover itself was difficult at times.  With each decrease of Clonazepam and increase of Diazepam, I would begin to feel horrible side effects within 48 hours.  Extreme fatigue, inner shaking and vibrations, nausea, paranoia and crying spells would take over for hours at a time.  It would last for approximately two days but proved to be a very LONG two days.  One time during the crossover I ended up on the phone with my husband while he was at work.  I was desperate and completely panicked.  I was absolutely terrified to be alone.  He left work early that day and it was also that day he had to explain to his bosses what was happening with me.  Both men were extremely understanding and had no problem with him leaving.  When my husband arrived at home, I was curled up on the sofa, holding my legs, shaking and crying.  It was instant relief the moment he stepped through the door.  I remember feeling like I may die that day.  That I would die and no one would know what happened to me.  That I would die alone with no one to hold me as I took my last breath.  I was convinced the medication was going to tear me apart inside and my heart would give up from exhaustion and stress.  When my husband walked through the door, I knew I wouldn't be alone, and that even if I did die he would be there to hold me in his arms.  I shudder at that thought now.   It is almost unfathomable to think a legally prescribed medication does this to some people.

Once I was stabilized on Diazepam, I began my taper plan.  I decided to make 1mg reductions every 7 days.  I can remember calling my local Pharmacist and asking for guidance with my taper plan.  She felt I should make 1mg cuts every 14 days, but I knew from research I had done that I could safely make the cuts every 7 days.  I figured if I tried it and it didn't go well I could always slow the taper down.  If I decided to make the 1mg cut every 14 days I would never know if I COULD have successfully tapered at a quicker rate.  My first few cuts went well.  If anything I felt a bit better on the Diazepam.  I still had several side effects but they were much more tolerable.  The one side effect that became much stronger with Diazepam was fatigue.  No matter how much sleep I had, I would feel exhausted by 1pm each day.  My eyes would burn and my head would bob if I sat to relax for a few minutes.

By the time I got down to 5mgs, I hit a wall.  For 17 days I suffered more greatly than I did during this entire experience.  Nausea, extreme stomach pain, panic attacks, chills, rib pain and fear became an almost constant for those 17 days.  Some days were more tolerable than others, but all and all it was an experience I would wish on no one.  My mom and dad made several trips to our house during those 17 days to help bring my daughter to school.  The three of us would sit in my family room as I cried and apologized for all of what had unfolded.  They would then remind me again that I didn't need to apologize.  I remember attempting to make dinner for my husband and daughter.  My dad kept me company in the kitchen and out of nowhere a stabbing pain in my stomach make me buckle over.  I cried and held onto my dad - terrified my stomach would literally explode.  The pains were so intense.  I remember during those 17 days, I thought the emotional and physical pain would never end.

It was a Saturday morning towards the end of those 17 days when I woke up in our guest bedroom.  It was 7:45am.  The bright sun was beginning to pour into the room and yet I woke up filled with fear.  I cried in bed and wondered how many more days, weeks or months I would have to go through this.  I walked downstairs and grabbed the phone and walked back up to the bedroom.  I called a good friend - knowing she would be awake with her 3 children.  I cried and she listened.  Just what I needed that morning.  I also called our Pharmacist.  She was amazing.  She reassured me that it was "normal" to experience all of this while coming off of Benzos - that they were often wrongly prescribed as well as over prescribed.  She had another patient coming in with similar problems coming off of Benzos.  She recommended I slow down my taper as it can often become more difficult the lower your dose gets.  From then on I switched my taper from 1mg cuts every 7 days to .5mg cuts every 5 days.  This didn't stop the side effects but somehow it made things a bit smoother.

Tapering from Benzodiazepines can be a scary experience.  You may often doubt the choices you make, but I found the most important thing was going with my "gut".  If my gut told me to slow down, then that's what I did.  You can wait for days or weeks trying to figure out what will possibly make your taper more tolerable.  It took me 10 months in total to taper off of Benzos.  Had the initial 25% cut of Clonazepam not hit me so hard I may have finished quicker, but I believe things happen for a reason.  I think in the end it was perhaps a positive thing I reacted so poorly because it allowed myself and my husband time to research Benzodiazepines.  It was through that research that we discovered the "crossover" technique where you crossover to a Benzo with a longer half life.  A longer half life means the medication stays in your system longer.  If it stays in your system longer than the cuts don't hit you as rapidly...making for a (hopefully) smoother taper.  My Psychiatrist had never done a crossover with any of her patients and in the end thanked me for teaching her a technique she could use for future patients trying to come off of Benzodiazepines. 

The process of tapering can be scary and quite daunting.  If you do experience unpleasant withdrawal effects it can make the time pass by very slowly.  It is important to follow a slow taper to reduce the chances of having a seizure.  Seizures are typically only a risk when coming off of them "cold turkey".  A slow taper allows your Central Nervous System to begin healing while still tapering and hopefully will spare you some horrendous side effects once you take your last dose and become "Benzo Free".  If you choose to come off of Benzodiazepines, the most important thing I can advise is to take your time and never will get there!

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