Xanax XR taper advice needed

I have recently been through a horrific experience with going off the EMSAM patch, a MAOI. My former pdoc who put me on EMSAM also put me on Xanax XR at night because of EMSAM's activating properties and insomnia side effects. (I realize benzos are not the best sleep med but trazodone hit me like a truck and I couldn't function in the morning, lunesta didn't work at all, and I stopped responding to melatonin quite quickly.) So I was stuck between a rock and a hard place. I terminated with that pdoc because he said ECT was my only option left since the EMSAM wasn't working anymore. It was also very difficult to convince him that my anxiety, insomnia, behavior, and mood swings were being caused by this medication, so I left his practice.

Now that the MAOI has finally left my body (it took well over the customary 14 days, I'm on Day 33), I found that 2 mg of Xanax XR became WAY too sedating. I noticed this all last week. Unfortunately, XR tablets are not scored and they don't come in anything less than .5 (unlike the immediate release). My pdoc agreed with me that I don't need as much. He wants to play it safe because other medication introductions haven't gone so well, my body is extremely sensitive to anything. He said he usually switches Xanax patients over to another med like Valium or klonopin and titrate from there, but given that I did not do well with the withdrawal from the MAOI nor the introductions of Cymbalta or Lamictal, we agreed that I should focus on titrating off Xanax XR first because the fatigue is pretty burdensome. Also, I would like to try Lamictal again but he told me to stop it 9 days ago because it was interacting too much with the Xanax XR, which you cannot just stop. I was so tired I was sleeping through alarms and missing work or showing up late.

I am on night 3 of 1.5 and it's not going so hot. 2 nights ago I slept for 10 hours straight due to all of the built up exhaustion, but when I woke up I instantly felt the "shakes", heart palpitations, tinnitus etc. upon waking up the first morning after taking it. I haven't been able to go anywhere all weekend, partly because my mood is in the tank and partly from this anxiety. It is almost bedtime here, I just took the 1.5 and I'm waiting for it to kick in, if it ever does.

Has anyone been able to lessen the horrible symptoms of a taper from Xanax XR, like spacing the dose out across the day, or adding a low dose IR? I do have 1 mg IR's that I use for dental visits and emergency panic attacks that are breakable to 0.5. My pdoc told me 2 days ago to check in with him in the next few days and that if I wasn't doing well he might see about switching me to the IR or a combo. He also wants me to try a baby dose of Cymbalta sometime this week but I don't know about that one.

I am under no illusions about benzos. I know Xanax (either kind) is the worst benzo to come off of. But I need to cut back because my system does not need as much of the drug anymore and I hate the interactions it caused with Lamictal. 2 mg was way too sedating. But it sucks just lying here dealing with these somewhat paralyzing withdrawal symptoms. I've got to go to work tomorrow. Thank you.

a switch to an equivalent dose of valium (sometimes librium) and a slow taper off that is one method of doing a more humane taper. to find you valium dose, multiply the xanax dose x 20. librium isn't as potent as valium, so your = dose would be higher. both valium and librium are more sedating but also have long half lives and come in a variety of strengths, so that makes tapers a lot easier.

Thanks, and I know what you're saying, but again - like I said, the issue here is that I have not responded well in the past month to *new* medications so my pdoc doesn't want to go that route with this. I already said why he doesn't want to switch me to Valium. I am looking for people who have stayed on Xanax XR or IR and were able to taper off some of it. I emailed him last night after I wrote my post and he told me to take a baby dose of the IR in the morning and (as needed) the afternoon. He said he doesn't want to put my body through anything else. The very fact that Valium and Librium are more sedating is something that I don't need right now, the Xanax XR is causing enough fatigue as it is. I have to be able to drive a car and go to work. Sorry if my reply sounded defensive, but maybe I didn't emphasize enough that I've been through significant trauma already because of that MAOI withdrawal.

So I think you are going waaay too fast. First of all, I don't know which benzo is hardest to come off of...I've heard that about every benzo. Anyway, I've been on Klonopin for 20+ years, and want to stop taking it as it stopped being helpful for me years ago. I started out at 2 mg./day and took a full year to go from that 2 mg. down to 1 mg. Now, I'm not suggesting that you take that long to titrate down your Xanax, but I do believe you'd have more success by taking at least 2 or 3 months to fully stop the medication.

I understand the desire to get off quickly, but honestly, in my experience going too fast off a benzo backfires. I've ended up extremely sick and messed up from doing a quick taper.

I never said anything about wanting to be completely off of it in, say, 1 month. I know that's totally unrealistic. My problem is that they don't make a Xanax XR pill smaller than 0.5 mg. So I had no choice but to go from 2 mg to 1.5 mg immediately.

I am extremely sensitive to valium. This works in my favor when manic but is also difficult because a small dose knocks me out more than necessary. A few years ago we tried using liquid valium to find a more specific dose. I read that a lot of people taper off valium with the liquid, reducing a milliliter at a time. I don't know if xanax comes in a liquid but if it does it might be a way to taper with very small changes so it's not so hard on you.

Thanks. It's like my body is going haywire with any little change I try to make and I have never been this hypersensitive to medication in my life. The MAOI's activating properties ruined my life, took double the standard amount of time for it to leave my system when I stopped it, had 2 bad reactions to introducing Cymbalta, can't handle Lamictal because the drowsiness + the Xanax was unreal, and the Xanax was making me horribly drowsy last week because there wasn't anymore stimulation from the MAOI to stop the Xanax from completely doing its job. One cut in the Xanax XR Friday night, with an option to take the IR as needed, and I'm still totally haywire with panic attacks, nausea, fatigue, and I'm going to miss work again today because I can't handle it. I can't do anything right. I'm a total dumpster fire right now. The whole thing is making me more depressed on top of the fact that I still can't get on another antidepressant because I'm getting sick from everything and I can't push through it.

I have found a level of Xanax, although it is IR, that does not cause me withdrawals. I think if I was to lower it, I would stay on that dosage and only use a tad lower dosage once or twice a week until I could add in more days.

That method would be very slow, but I also think it is the safest one. Also I would allow in times of crisis, a crisis dosage that was higher, since it is your regular dosage your body gets adapted to, not a crisis dosage every 14 days or so.

I can't fathom tapering half a mg!.. and every day! Way way too fast.

You can probably work out a better schedule switching some of that to IR.

If I was to taper the way I said above, it would not be a daily taper and I would taper 0.125 at each step.

I'm sorry you're going through a rough time. Up until a few months ago I was on 3 1 mg of Xanax IR and 2 mg of ER and 4 Mg of Klonopin. None of this was sedating for me. My doctor cut out the IR and told me to take 4 mg of Klonopin and save the ER for panic attacks (how is ER going to help a panic attack). I've been through Xanax withdrawal before and it's miserable so I feel for you. It must be the 4 mg of Klonopin keeping the withdrawals at bay. Good luck and I hope it gets better soon.

Thanks for your replies, I've been rather unwell from this mess as well as ongoing back pain so I didn't check back in this thread until now.

The decrease by 0.5 mg was not supposed to occur every day. I was supposed to stay on 1.5 indefinitely. But this is a moot point because I'm back at 2 mg. I had a very erratic day 1 week ago and the next day (Tuesday the 11th) I was such a basket case I couldn't go to work. I emailed my psychiatrist and got an auto-reply saying he was out of the office for a week. I was kind of angry he didn't tell me he was going on vacation, but I didn't say anything because I've been having temper control issues lately and I didn't want to "bite the hand that feeds", so to speak. So since I was effectively on my own (I will never call the "on call" person because I am not suicidal or clinical), I made an executive decision to go back to 2 because my quality of life was better before the taper, despite the fatigue. He ended up writing back later that day telling me to do the same thing.

In the meantime, I am very slowly introducing Cymbalta (a non-therapeutic baby dose). I am now on nothing except Xanax and I can tell because the difference in my mood is not good. I checked in with my pdoc again today and all he said was to go up to the full dose of Cymbalta and continue with the 2mg XR. He didn't respond to anything else in my message, where I also said I am in great distress in the mornings and there's no thinking, talking, exercising, or breathing my way out of this panic upon waking up; or that I felt kind of hopeless. The instruction to proceed with the full dose of Cymbalta must have been his response to everything.

He must be busy coming back from vacation or something. Oh well.

Yeah, ER makes no sense to me for a panic attack either - it takes too long to kick in. I've tried it for panic attacks when I didn't have any IR and the panic attacks mostly exhausted themselves hours later before the ER started up. I think your doctor may have taken away your IR because they collectively are getting really worried about prescribing controlled substances. There's a ton of prescription drug abuse that's going on in the US (where I live). That's my take anyway.

Do you or anyone else reading this have "morning" terrors? I've heard of night terrors but I have this thing where I instantly panic upon waking up, even if it's not a work day. It's quite distressing and debilitating. It happens even when I've taken the 2 mg XR the night before, weekends included. Sometimes I have to resort to taking a 0.5 IR to totally "kill it off" for the day. One day in January I had a panic attack that lasted for 17 hours and I didn't have an IR script at the time. I know what set it off, but the duration was just hell and I'm terrified of that happening to me again. I tried everything that day, everything all the "experts" say [breathing, walking outside] and nothing worked.

In any event, I'm back on 2 mg for the foreseeable future. At least I can say I was able to complete a horrific MAOI cessation without having to turn back.