Re: my introductory story - Carol on Lexapro

[Guest guest]

hi,Carol;

The Lexapro was no problem for me. I did an 8 week trial at 20

mg/day 2 1/2 years ago. I had no side effects, but no beneficial

effects either, so I tapered off over a month, as per doctor's

instructions. I had some minimal withdrawal symptoms for about 6

weeks or so after that, but then they completely disappeared. I had

the infamous SSRI brain zaps - turning my head sharply would produce

a half second sensation of a little zap going through my head, but it

wasn't troublesome at all. I also had addominal spasms, most likely

the smooth muscle of the lower intestines. My gastroenterologist

prescribed Dicyclomine 10 mg three times a day,and they immediately

cleared up, and after four weeks I came off the Dicyclomine, and the

intestinal spasms were completely gone. The brain zaps soom

disappeared completely as well.

I would be happy to go through a million of those little withdrawals

that just one of these incredible Valium withdrawals. We're all

different, and my system just loves what Valium does to relieve the

symptoms of my underlying disorder, so it naturally exacerbates it

tremendously when I came off of Valium at far,far too fast of an

initial taper (down 2/3 in 3 weeks, as per doctor's orders). My

dilemma now, after getting blasted from the too-fast Valium taper,and

still having nasty Valium withdrawal symptoms 18 months later. I

need to figure out the best dose of Valium to be on now (hold,

updose?) to begin a properly slow taper from there.

I hope I'm able to consult with . I don't speak, which

makes phone consultations a bit tough.

Thanks for you input on the Lexapro, but I felt fine for two years

after I came off of my brief trial. It was the Valium near-cold-

turkey that walloped me.

alex

..

> >

> > Hi;

> >

> > You mentioned that you preferred introductions to be as detailed

as

> > possible. I hope I didn't go overboard.

> >

> > Valium is the devil that got me.

> >

> > I'm 54 now. Until I was 37, I had enjoyed perfect health and a

> great

> > life. Work I loved, friends I loved, worked out, ate well since I

> > was 17, travelled….

> >

> > Then problems arose. At first I began having frequent recurrences

> of

> > vertigo, which I had had only once every 4 years or so since my

> > 20's. I now know that it is Benign Paroxysmal Positional Vertigo,

> > (BPPV), brief bursts of vertigo upon change in head movement,

> caused

> > by free floating calcium carbonate crystals in the semi-circular

> > canal, which have broken off from the macula. It wasn't

understood

> > at the time (I had to do a ton of research, and finally

discovered

> a

> > doctor in Paris who had just published a new theory and cure for

> it –

> > repositioning the particles out of the canal – which is now the

> > accepted theory and treatment worldwide. I immediately went to

> Paris

> > and got the vertigo cured). Shortly after the frequent vertigo

> > spells began, I also developed other symptoms – I would find that

> > speaking loudly would cause a systemic tension, which would last

> for

> > a half hour or so – as if in tensing my body to raise my volume,

> the

> > tension just lingered instead of just relaxing immediately as

> > normal. Then I woke up one night with tinnitus and a strong

> feeling

> > of tension. I fell back asleep, and when I woke up, the tension

> was

> > gone, but the tinnitus has never stopped. When I learned that

> it's

> > not understood, and would likely never go away, I felt enormous

> > distress for months, as it wasn't a " ringing in the ears " as much

> as

> > a whistle so high pitched that it often sounded like a fingernail

> > being dragged down a chalkboard (over the years it has lowered to

> > just a constant whistle, and causes little concern). Within days

> of

> > that developing, I also developed a strong sense of contraction

in

> my

> > hard palate, which began sporadically, but soon became permanent,

> and

> > still remains.

> >

> > Before I found the Parisian doctor who cured my vertigo, I had

> been

> > improperly treated – encouraged to roll around a lot to make

myself

> > really motion sick so my brain would habituate, which I did for a

> > short time until the motion sickness was too much to bear.. But I

> > then began to be very susceptable to motion sickness – small

> > repetitive head movements would make me sick for days. Around

this

> > same time, I developed a chronic sense of elevated tension, which

> > would be exacerbated whenever I spoke either loudly, or while at

> all

> > tense or excited. It would usually die down wthin a half hour or

> > so. But the lower level chronic tension remained.

> >

> > This eluded all diagnosis. Tons of tests came back normal, and

the

> > only few abnormalities (after my BPPV had been cured - vestibular

> > hyperreactivity and a large Chvostek sign, both discovered by my

> > curious Parisian doctor. I got a tentative diagnosis

> > of " spasmophilia " – a European diagnosis which describes a state

of

> > neuromuscular hyperexcitability. The main treatment is magnesium

> and

> > Vitamin D metabolites, which I tried but which did nothing, or

> > anxiolytics.

> >

> > When I returned to the US, I consulted various doctors, and

learned

> > that spasmophilia in the US would fall into the category of an

> > anxiety disorder. I read up on those, and simply didn't fit any

of

> > the categories. The closest thing my symptoms resemble would be

> > Generalized Anxiety Disorder – with no anxiety, just some of the

> > somatic symptoms (primarily excess tension and the inability of

my

> > body to relax). But as the hallmark symptom of GAD is considered

> to

> > be excessive worry, I didn't fit that at all – I never have been

a

> > worrier, I've always been easy-going, and just dealt with

whatever

> > was present, with no " what if " scenerios being spun in my mind,

so

> I

> > dismissed that diagnosis. Interestingly, lately I've learned

> > that " worry " as a main symptom in describing GAD is

controversial –

> > that many argue that worry is only one manifestation of GAD, and

> that

> > there are a large number of people like me, who have strong

somatic

> > symptoms of GAD, but no verbal/cognitive symptoms. They propose

> that

> > GAD should be split into two diagnoses – generalized anxiety

> disorder

> > for worriers, and generalized tension disorder for non-worriers

who

> > have the relentless somatic symptoms of GAD. Also interestingly,

I

> > recently ran across a study which followed up patients who had

gone

> > through a serious bout of BPPV and been eventually cured of it –

> 40%

> > developed a clear anxiety or panic disorder shortly afterwards.

> The

> > speculation is something in the limbic system got kindled or

> > hypersensitized during all the vertigo.

> >

> > Anyway, my symptoms all remained stable for 13 years, during

which

> I

> > alternated between first trying every alternative treatment

known,

> > with no benefit, and various medical trials to see if anything

> > reduced the most distressing symptoms at the time (the tinnitus

and

> > the palate pain – the tension was annoying, but livable).

> > Nortriptyline, Ergonovine, Meclazine, 25 mg/day of Valium for 6

> weeks

> > (came off in 4 weeks with no problem), atenolol, low doses of

> > Neurontin and then Topamax, Prozac, Effexor (nothing had any

> benefit,

> > or any bad side effects, or any problems on discontinuation,

except

> > for a couple of months of little " brain zaps " after the Effexor –

> no

> > big deal, and soon gone), and just not doing anything and just

> living

> > with it.

> >

> > Then in 2004, I had a big leap in symptoms. During a moment of

> high

> > stress (late for a very important appointment, lost, and running

> out

> > of gas), my old " motion sickness " returned (it had been

essentially

> > gone for 10 years) for a 7-day bout. After it resolved, both my

> > chronic baseline of tension, and its exacerbations were 3 to 4

> times

> > worse, and just remained. I could now also trigger strong

> > exacerbations by doing anything that involved tensing the front

of

> my

> > torso – doing a sit up (I can still do a full gym workout with no

> > problem, but one sit up equals 12 hours of exacerbation) , doing

a

> > yoga stretch involving bending forward and holding, pulling

myself

> up

> > from a slumped sitting postiion…..Back to the doctors for more

> tests

> > (all essentially normal, except for lid lag, a sign of

> > hyperadrenergic activity, and a ton of microsaccades – no

> > explantation for that). No diagnosis, and the only suggestion,

> since

> > none of the alternative treatments (relaxation, meditation,

> > acupuncture, rolfing, massage, chiropractic, psychotherapy, etc

> etc)

> > had any beneficial effect, was to try different medications to

see

> if

> > anything would provide symptomatic relief.

> >

> > Atenolol, 50 mg/day, 5 days, no benefit

> > Soma, 1,050 mg/day, 5 days, mild benefit on the chronic baseline

> > tension

> > Baclofen, 20 mg/day, 3 weeks, no benefit

> > Klonopin, 2 mg/day, 2 weeks, some benefit on both the baseline

> > tension and the exacerbations brought on by speaking or tensing

> >

> >

> > It was next suggested that I try Valium. At first, I tried it on

> an

> > as-needed basis, and it seemed to work beautifully. I tried 7 ½

mg

> > before several long business meetings and social events, and

found

> > myself talking with no problem at all. I was strongly encouraged

> to

> > begin taking it on a continual basis, at a higher dose. I began

> > taking 22 ½ mg/day continuously. I noticed a strong reduction in

> my

> > chronic baseline tension, and a fair degree of reduction in both

> the

> > frequency and intensity of my exacerbations from speaking – they

> > weren't as easily triggered, and when they were, they weren't as

> > strong or long-lasting. The painful feeling of tightness and

> > contraction in my hard palate was also reduced by about 50%. (As

> for

> > the exacerbations provoked by upper body contraction, I had

simply

> > stopped doing any action which was a known trigger for those

> > episodes).

> >

> > After about four months, the baseline tension was still reduced,

> but

> > the exacerbations from speaking began to return, although still

> > reduced in intensity. I was given a trial of Lexapro, 20 mg/day,

> for

> > 10 weeks, and I was encouraged to continue taking the Valium at

22

> ½

> > mg/day throughout that trial. When the Lexapro showed no benefit,

> I

> > was tapered off of it. I had a fairly strong withdrawal from it

> (the

> > infamous " SSRI brain zaps " , and strong intestinal spasms, which I

> had

> > NEVER before had in my life – and I'm a fan of the hottest Thai,

> > Mexican, and Pakistani food you can find). I was prescribed a 4-

> week

> > trial of Dicyclomine, 10 mg/T.I.D., which instantly stopped the

> > intestinal spasms, and by the time I had discontinued the

> > Dicyclomine, the spasms were only mild. Both the " brain zaps " and

> > the remaining mild intestinal spasms completely resolved about 8

> > weeks after stopping the Lexapro, and didn't return.

> >

> > After that, I was given a trial of Zyprexa, 10 mg/day, and again

> told

> > to stay on the Valium, still at 22 ½ mg/day. After 4 weeks of the

> > Zyprexa, with no additional benefit, I was taken off the Zyprexa,

> > with no problem. My doctor's next suggestion was that since

Valium

> > was the only thing that had ever provided a significant benefit,

I

> > should increase the dosage to 30 mg/day, which I did for 8 weeks,

> but

> > it gave only a small additional benefit. Since I was still having

> > significant problems with speech causing exacerbations (and, in

the

> > meantime, I had also discovered that I was still able to provoke

> > exacerbations with mild upper torso contractions) , I decided I

> wanted

> > to come off of the Valium, and clear the decks for some trials of

> > other medications that other doctors had suggested (primarily

anti-

> > convulsants at higher doses than I had previously tried). I had

> now

> > been on the Valium continuously for about 14 months. My doctor

> > instructed me to taper off of the Valium over 6 weeks, dropping

my

> > dose by 5 mg/day each week. This was in October of 2006.

> >

> > I had no problems, until I got down to 10 mg/day. Then strong

> Valium

> > withdrawal symptoms began to hit me. The first withdrawal symptom

> > was insomnia (I've NEVER had insomnia in my life), followed

quickly

> > by extreme noise sensitivity (I've NEVER had noise sensitivity in

> my

> > life), followed by the discovery that speaking even a little

could

> > now provoke stronger exacerbations of my symptoms than a 3-hour

> > conversation used to provoke prior to my use of the Valium.

> >

> > At that point, I read almost everything published in the medical

> > literature in the last 20 years on Valium discontinuation, and

was

> > pretty mortified at what I learned. Roche, the manufacturer,

> > recommends that Valium not be used continuously for more than 4

> > weeks. Many countries' governmental agencies have sent warning

> > letters to all physicians instructing them to never use

> > benzodiazepines for more than 2 to 4 weeks continuously, except

for

> > rare cases (stiff-person syndrome, cerebral palsy…), because the

> risk

> > of tolerance and protracted, difficult withdrawals even with

> gradual

> > discontinuation. The FDA finally caught up with the rest of the

> > world, and now says that benzodiazepines should not be used for

> more

> > than 2 to 4 weeks continuously.

> >

> > I tried to hold at the 10 mg/day dosage, but when I provoked a

> > profound 5-day bout of " motion sickness " simply by having some

very

> > gentle sex with my girlfriend – my first bout since my 2004

> episode,

> > and the first one ever provoked by such a mild stimulus – I

> realized

> > that I had come off WAY too fast, was in a state of unprecedented

> > neural hyperexcitability, which, among other things, now had me

in

> a

> > much greater susceptability to my " motion sickness " (this would

> make

> > sense, as Valium is a potent motion sickness preventative, and

> being

> > in Valium withdrawal is like being on anti-Valium – whatever

> > neuroadaptive changes that had taken place while on a continual

> > dosage can be very slow to reverse (changes in GABA receptor ion

> > channel efficiency, glutamatergic system becoming more active,

> > posssibly the adrenergic system as well - no one seems sure

> exactly

> > what all the compensatory changes are – there may be many). I

> found

> > the Ashton Manual, digested all of that, and knew that I had to

> > updose, stabilize, and try coming off much more slowly.

> >

> > I went back up to 15 mg/day, and within a week, felt much better.

> I

> > held that dose for 3 weeks, added Hydroxyzine (10 to 20 mg/day –

a

> > study had shown some benefit for withdrawal), and then began to

> > reduce my dosage by 1 mg/day each week. When I got to 12 mg/day

> > (December 29, 2006), I began to get tremors (I had never had

> tremors

> > before in my life), overt tics, twitches, and muscle

fasciculations

> > (never had any of these before in my life), and mild-to-moderate

> > lower abdominal spasms (I had never had that before, except

during

> my

> > Lexapro withdrawal, and they had abated completely). I decided to

> > hold it at that dose until these withdrawal symptoms subsided

> before

> > resuming my taper. I was again, as after the Lexapro, prescribed

> > Dicyclomine, 10 mg/T.I.D. for 4 weeks, for the abdominal spasms.

> > Shortly after beginning the Dicyclomine, the abdominal spasms

> > increased and became more widespread. I also developed a new

> symptom

> > which I had NEVER had in my life. Any time I would hear ANY

> > unexpected sharp sound, I would have a strong startle reaction,

> > followed by several hours of painful muscle tension and

> contraction.

> > Since the world is nothing BUT continual unexpected sounds, this

> was

> > being evoked constantly. Eventually, I had to begin wearing

> earplugs

> > and headphones full of white noise to drown out environmental

> > sounds. It worked well at home, but outside, a variety of noises

> > overcome that (car horns, screaming children) and set off the

> painful

> > aftermath. At home, I would often take off the headphones and

> > earplugs, but any tiny unexpected sound in silence – a window

> > rattling, a distant car horn – would set if off. For my whole

life

> > prior to this, you could literally sneak up behind me and scream,

> and

> > while you would naturally get my attention, I would have

absolutely

> > no symptom of any kind afterwards. Now, if someone drops a penny

> on

> > the floor, I'm in pain and discomfort for hours.

> >

> > After 4 weeks, I read the PDR on Dicyclomine and pointed out to

my

> > Gastroenterologist that " abdominal pain " and " increased nervous

> > excitability " were possible adverse effects of Dicyclomine. He

had

> > me stop taking it, and my widespread intestinal spasms quickly

died

> > down, and I was left with just the localized lower abdominal

spasms

> > that I had had prior to the Dicyclomine, but the startle reaction

> and

> > its painful aftermath have continued ever since (presumably just

a

> > classic Valium withdrawal and rebound symptom, unrelated to the

> > Dicyclomine, altough I've always wondered, since exagerrated

> startle

> > reaction is a classic anti-cholinergic side effect, but usually

> > abates upon discontinuation of the drug, and I was on a very low

> > dose).

> >

> > Interestingly, despite these withdrawal symptoms, at the 12

mg/day

> of

> > the Valium, my chronic baseline tension was still much lower. For

> a

> > while….

> >

> > On March 27, after an odd head infection, I had a brief episode

of

> > vertigo (my typical BPPV). Because of my neural hypersensitivity

> and

> > hyperexcitability from the Valium withdrawal, I decided to skip

the

> > repositioning cure to let it resolve on its own. I felt no after

> > effects from the vertigo. A few days later, I turned on my TV

> (sound

> > off, to avoid startle reactions). I couldn't have picked more

> insane

> > moment to do it. The screen had a commercial on it, featuring a

> > white logo jumping around against a black background at about 5

> times

> > a second. Within seconds of watching this, I became nauseated,

and

> > as I continued to watch a silent basketball game, another strong

> > episode of my " motion sickness " kept growing. This was the first

> > time that a simple optokinetic stimulus had managed to provoke

> > a " motion sickness " episode. It continued unabated for the next 7

> > days, at which point I wondered if perhaps my BPPV was

contributing

> > to this. I tested it, found that it was still active, and did a

> > maneuver to clear my left posterior semi-circular canal.

> > Immediately, my nausea ceased, but just as quickly, my old

baseline

> > chronic tension, which had been essentially gone since I began

the

> > Valium, and had stayed gone despite the other withdrawal

symptoms,

> > returned, and has now remained ever since. This seems to be a

> third

> > quantum leap up in my main chronic symptom, brought on either by

> > the " motion sickness " episode, or else by the maneuver itself

> (strong

> > upper body contractions during the maneuver?), although a

maneuver

> > has never before resulted in any type of residual symptom. Around

> > that time, I also discontinued the Hydroxyzine, as that was

> > apparently not giving any benefit.

> >

> > There has always been an odd aspect of this chronic baseline

> > tension – I notice it much more anytime I do anything that

> contracts

> > any small area of the front of the body. If I'm laying down on my

> > back, it will increase a lot if I bend my knees, thus contracting

> the

> > front of my hips, but will immediately decrease when I straighten

> out

> > my legs again. Or sitting down (again contractinging the front of

> > the hips) will increase it; standing back up will bring it back

> > down. Sitting down and leaning forward, thus contracting the

front

> > of the hips even more, will increase it even more; and again,

> > straightening back up will immediately eliminate the increase.

> > Simply casting my eyes downward far enough will increase it;

> casting

> > them up a bit will stop the increase. It just seems as though any

> > small, held contraction in the front of my torso really

accentuates

> > the tension, to the point that I begin to feel some jitteriness

to

> > it, for as long as I hold that contraction, but as soon as I undo

> the

> > small contraction, the accentuated tension immediately ceases,

and

> it

> > just returns to its baseline. Similarly, most all of the physical

> > actions which provoke the really strong and long-lasting episodes

> of

> > exacerbation (which do NOT cease upon undoing a held position,

but

> > continue for 8 to 36 hours) seem to involve a very strong, brief

> > contraction of the front of the torso.

> >

> > On April 29, after having avoided watching any TV since my

> > optokinetically- provoked " motion sickness " episode, I watched

> another

> > silent 30 minutes of a basketball game, and again provoked a 3-

day

> > bout of " motion sickness " . This one resolved, leaving no

> additional

> > symptoms (i.e. – increased tension) in its wake.

> >

> > Finally, after 6 months of enduring the withdrawal symptoms,

> > patiently waiting for them to subside, I decided that I had

simply

> > come off way too fast, and that the best strategy for my long-

term

> > health would be to updose a bit, hopefully eliminate them,

> stabilize,

> > and then resume my much slower taper off from there. On July 18,

> > 2007, I updosed to 15 mg/day (the dose I had been on in December,

> at

> > which I had felt reasonably okay). The updose had no effect,

until

> > about four weeks later, at which point the intestinal spasms, and

> > muscle twitches and tremors stopped. But the painful muscular

> > aftermath to any auditory startle persisted, and after very one

> > strong provocation, seemed to become both stronger and easier to

> > provoke, as if it had been kindled, or sensitized. Before, small

> > auditory startles were no problem, and moderate ones would cause

a

> > few hours of painful muscle tension, which I could often

eliminate

> it

> > with 15 minutes of focused muscular relaxation exercises. After

> this

> > strong provocation( and continuing to date), a smaller stimulus

can

> > provoke the muscle tension, and a moderate one can provoke both a

> > stronger and longer-lasting muscle pain and tension, which can't

be

> > relaxed away, and lasts for 6 to 8 hours, and also provokes a

> > feeling of alarm and hypervigilence and strong hyperactivity that

> can

> > last for a half hour or so – as if the normal reaction that one

> would

> > have to a startle – a nanosecond of alarm which immediately

> > disappears, simply has nothing to stop it, and persists. During

> my

> > whole life, and during my chronic, undiagnosed disorder, before I

> was

> > prescribed the 14 months of Valium, I NEVER had any feeling of

this

> > kind. Oddly, even while in this Valium withdrawal, I have been in

> a

> > couple of threatening situations in which alarm or panic would be

a

> > reasonable response, but I had my normal response that I've had

my

> > whole life – I felt the danger, but cooly assessed the situation

> and

> > figured out the best strategy to deal with it – and had

absolutely

> no

> > physical symptoms accompany a dangerous ordeal and the normal

> anxiety

> > that came with it. But if I'm not looking and you drop a penny on

> > the floor right now, you'll set off a feeling of alarm that will

> > persist for a half hour or so, followed by 4 to 6 hours of muscle

> > pain, tension, and hyperactivity

> >

> > I consulted an addiction specialist who has gotten thousands off

of

> > benzos, and on his advice, tried several treatments. He routinely

> > tapers anyone off of benzos by first getting them on 300 mg/day

or

> so

> > of Lyrica, and then doing about a 6 month benzo taper, and then a

> > period of remaining on the Lyrica, then a slow Lyrica

> > discontinuation. But I've learned to be extremely cautious with

> > medications now, so I first tried a baby trial - 150 mg/day for 4

> > weeks. It helped a bit with the startle aftermath, but not much.

> I

> > tapered off of the Lyrica over two weeks, with no problem at all.

> > The next was several " Valium challenges " . My doc wasn't sure

> whether

> > my symptom was truly Valium withdrawal, and the best test for

that

> is

> > to increase one dose of the Valium, temporarily raising the

steady-

> > state level of the drug. I had been on 15 mg/day of Valium for

> > several months at that point (5 mg TID). Given Valium's long

> > halflife, and the longer halflife of its active metabolite, at 15

> > mg/day, I have a steady state level of anywhere from 50 to 90 mg

of

> > Valium in my system at any given time. The protocol for a

> challenge

> > is to take one increased dose, and then skip the next doses to

make

> > up for it, for example, instead of 5 mg TID, take 15 mg for my

> first

> > does (raising my steady state level by 10 mg), and no more for

the

> > rest of the day. I get to see how the temporary updose affects

me,

> > and by the next day, am back to my usual level, so have avoided

> > adding additional tolerance.

> >

> > The results of my challenges so far have been that if I raise my

> > steady state level by 10 mg, it helps a little, and if I raise it

> by

> > 15 mg, it helps a lot – in fact, as far as I was willing to test

it

> > the two times I did that, I didn't have a single auditory startle

> > reaction. That was months ago, but if that is still the case, to

> > raise my steady state level by 15 mg would require an updose from

> 15

> > mg/day to somewhere around 18 to 20 mg/day. It's a tempting

> option,

> > but one my addiction doc advised me against,as it could just

cause

> > more tolerance. His preference was finding an adjunctive

> medication

> > that could cover the worst symptom (the startle and its

aftermath,

> > which has been essentially incapacitating) and very slowly resume

> the

> > Valium taper. He has since retired, and is no longer available to

> > consult.

> >

> > But with that gone, I resumed my next trial for the startle and

> > aftermath of painful tension – I had read that PTSD patients with

> > exaggerated startle reactions had the same levels of plasma

> > noradrenaline when startled as controls, but highly elevated

levels

> > in CSF, so many are being treated now with noradrenergic

> > antagonists. I've tried a series of trials of Propranolol, which

> at

> > a moderate dose, blunts the startle and its ridiculous aftermath

by

> > 80-90%, but I have low/normal blood pressure, and at that dosage,

> I'm

> > getting as low as I can possibly get. I discontinued my last 4

> week

> > trial about a month ago, with no problem – just the startle

> reaction

> > returning. I've also tried some brief trials of Clonidine, with

> the

> > same benefit of stopping the startle and its aftermath, but is

> fairly

> > sedating.

> >

> > So at the moment, I remain on 15 mg/day of Valium, feeling okay

if

> I

> > hear no noises through my earplugs and white noise, but if I do,

> > feeling strong discomfort for hours, so I'm pretty much

homebound,

> > except for jogging in quiet parks with headphones full of white

> > noise. Music and television or DVD's are out. Speaking causes

> > greater exacerbations still than it ever did before I touched the

> > Valium, so my social life is dead. I manage to take care of my

> > business, but at 10% capacity.

> >

> > And I find myself debating the options of where to go from here:

> >

> > 1 – Keep holding at 15 mg/day and wait for withdrawal symptoms to

> die

> > down so I can resume a very slow taper, but that haven't died

down,

> > and I've been at this dose for a year now.

> >

> > 2 – Updose to whatever it takes to make this symptom go away.

Very

> > tempting, but I'm concerned about simply getting a temporary

> relief,

> > and as I resume a very slow taper from my higher dosage, just

> > building up more tolerance so that when I get back down to 15

> mg/day,

> > my withdrawal symptoms will either be the same or worse.

> >

> > 3 – Continue to dabble carefully with adjunctive medications to

> > eliminate the startle reaction, and if I can find something that

> > covers it that doesn't have the ferocious dependence and

tolerance

> > issues that Valium has, continue to take it through the rest of

my

> > Valium taper, to get that nasty drug out of my system, and then

> > carefully taper off of the adjunctive medication (the only real

> > candidates are Propranolol and Clonidine, or various anti-

> > convulsants – Lyrica, Neurontin, Topamax, or Carbamazepine)

> >

> > Each option has its pros and cons; its risks and benefits.

> >

> > I'm very curious to hear your thoughts and opinions.

> > alex

> >

>