Between Doses

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  • Stopping benzos – my journey so far

    Stopping benzos – my journey so far

    Wednesday, September 17, 2025 was the last time I took Valium. I’ve been prescribed it since I was 17, making it a 23 year run of benzo dependence. I was down to 2.5-5mg every couple days. Still, it was a stupid thing I did (stop basically cold turkey) and my reasoning was more if I could, than if I should. I don’t recommend stopping any medication without a doctor’s advice, pharmacist watching over, and taper plan. I wasn’t dependent enough on it to have withdrawal seizures, fortunately, but this is not a guide or advice.

    It’s been a pretty wild ride. I admit it was more of an if I could. I admit, I’m pretty stubborn sometimes, and I’ll do things just to see if I can. This was basically that. Then I got caught up in it, gave my pharmacist my extra pills, and haven’t taken valium since. My doctors are.. not terribly impressed with my stupidity, but some of them are pretty pleased I’ve stopped taking benzos.

    I’ve had a few cognitive side effects from different medications: Invega, Valium, Topamax, being the big ones. I’ve been on benzos for decades, and I haven’t really been to my baseline since I was 17 years old. So I sort of set out to test myself. I got through the first couple days, most were pretty bad, I had weird side effects, but known ones, like hot flashes, vivid dreams, restlessness, and some mild hallucinations. I was kind of out of it, and feeling this floaty sensation, like I was outside of my body, and I had never heard of it before. I learned later it’s called residual disequilibrium.

    After the first week, the main physical side effects were gone, like the hot flashes. It had been a hot September, and the temperature went down a bit too. I wasn’t having full out panic attacks after the first week, and things were settling down. I knew I had to get rid of the extra pills, because if I didn’t, I’d take them in a moment of weakness. So I gave them to my pharmacist to dispose of. I no longer had any valium.

    Note that I wasn’t abusing valium, besides being dependent on benzos, and trying to see what life would be like without them. I wasn’t using more than prescribed, or taking them because I was bored, pretty much only as absolutely needed. I had gotten down from 20-30mg a day to 0-10mg a day in 2022-2023, and settled around 0-5mg a day a couple times a week until then. This is of diazepam, not another benzo. I had cross tapered from clonazepam to valium at one point.

    It was hard. The side effects got weird. My mind got sharper. I was above baseline anxious, but not much more. I started using more CBT and DBT techniques to manage, using reality checking, things like that, to deal in public. The Abilify started hitting steady state and the Saphris was increased to 10mg, and this helped some, too.

    My meds are being adjusted still, but I’m cutting benzos out. I don’t advise this. Don’t stop your benzos because you want to test yourself! I’m an idiot sometimes, but that’s my story. My psychiatrist told me I’m lucky I didn’t stubborn myself into a seizure.

  • The Curse of Insight In Psychosis: A Patient’s Perspective

    What is insight in psychiatry?

    Insight in psychiatry is defined as

    • having awareness of your illness (Awareness)
    • knowing that your symptoms are abnormal (Attribution)
    • agreeing that you need treatment for that illness (Action)

    Insight into your illness is considered a good thing and a positive towards successful treatment, but there can be a devastating paradox that comes with recognizing that you’re sick and need help.

    The Paradox of Insight

    The paradox of insight in schizophrenia means that increased levels of insight are also associated with higher levels of depression. [Source] This can make it easier to hide, harder to be helped, and more painful to live through.

    If you have insight, this indicates that you already know how you’re supposed to act and you see yourself and know that it’s not supposed to be that way – but you can’t change it. It’s easier not knowing.

    You unfortunately understand the language of mental health well enough to manipulate the narrative – even unintentionally.

    This can mean saying, “I’m fine!”, because you know better than to not say that, you know what could happen, like stigma, involuntary hospitalization, stronger medications, and so on.

    There is a core contradiction in this, and it is as follows:

    “If I admit I’m struggling, they might not believe me. But if I don’t, they definitely won’t”

    Insight makes the pressure to appear okay even though you aren’t, very strong. In my case, some people are watching for signs of illness, and I’m looking back trying to convince them there are none.

    • Eye contact? Yup
    • Not rambling.. sorta
    • Smiling, yep.

    “”If I mimic normalcy enough, I can avoid hospitalization, stigma, and disappointing everyone again. “

    This leads to being told, “you seem better”, “you don’t sound psychotic”, and “you’re so self aware, what a good sign!”. It makes you the model patient, it sets expectations, and now people are depending on you for something else.

    Insight can feel just like a trap sometimes, because you know you’re unwell buy you’re also unable to stop it, which can be just as terrifying, if not more, than being delusional or hearing voices.

    • You can pretend it’s not happening
    • You still feel crazy
    • You can predict your own decline – and dread it

    Then the thoughts start

    • If I was really sick, I wouldn’t be this aware
    • Maybe I’m exaggerating
    • If it was serious, someone would have noticed.

    It’s a trap, it’s a cycle, and then when things fall apart, you’re at your worst, it really is a crisis now, and it could have been avoided if you tried to get help, or asked for help, a long time ago.

    Insight can make you doubt your own suffering more than any delusion ever could.

    Sometimes you try to get help and they consider you too insightful to be helped. Insight is often seen as lack of risk, why?

    “You’re not yelling or refusing meds? You aren’t claiming to be Jesus? You must be fine!“

    However, the people with insight are often the ones most likely to hide distress, and the least likely to be believed when they do disclose it. You can be considered too rational to be a danger to yourself, but you can also be rational enough to lie about how close to the edge you are.

    We hide it, there are reasons. I’m not scared of being sick, I’m scared of admitting I am! There’s a huge list of fears here:

    • Hospitalization
    • Loss of autonomy
    • Not being believed
    • Disappointing family
    • The permanence of your history/diagnosis

    And even fear that this time help may not come, and be told you’re too functional, but that’s never happened to me, fortunately. Keeping quiet can make it seem like you’re in control of the eventual fallout. This isn’t 100% true, or guaranteed, either.

    Insight doesn’t mean you’re stable, it doesn’t mean you’re safe and it doesn’t mean you’re being honest. Sometimes you’re the most at risk because you’re articulate, and because you’re two steps ahead of the system because you don’t want to get caught in that system. Sometimes the fear of the guilt, the shame, and the fallout, is worse than admitting you’re sick in the first place.

    If you know someone you think is sick and may be hiding it

    • Ask how hard they’re working to be okay
    • Ask what they aren’t saying
    • Validate the fear of speaking up

    Don’t assume insight means someone wants help – or feels safe getting it.

    For Other Patients

    • you’re not weak for knowing and still struggling
    • you’re not faking it because you can describe it
    • you’re not safer because you can understand it

    The pain from the whole experience, being told I was insightful, that I was a great patient, all that stuff, just made it harder to be sick, say I were inpatient or something. I hid side effects, paranoia, hallucinations, because I didn’t want to be a bad patient, a burden, medicated against my will.

    Insight didn’t save me, it just made me feel the whole thing in high definition

  • Current Meds, Currently Kinda Stable

    Current Meds, Currently Kinda Stable

    This is a first post and sort of “where I am right now” compared to where I’ve been for the past little while and what meds I’m on, what’s working, what isn’t, and potential changes coming up.

    The Main Meds

    Abilify Maintena – Long Acting Abilify Injection

    Abilify Maintena is a monthly (28 days) long acting injection of the antipsychotic abilify (aririprazole). Abilify is an atypical (third generation) antipsychotic and is a dopamine-2 (D2) partial agonist, meaning it lowers or raises dopamine when it is out of balance. It is also a partial agonist at serotonin 5-HT1A receptors and an antagonist at 5-HT2A receptors. This is unique to Abilify and helps balance serotonin and dopamine without the powerful blockade of some atypical and typical antipsychotics. This can also mean it’s more activating, causes insomnia, and can cause anxiety and restlessness (akathisia).

    I find it pretty decent – the injection isn’t as painful as the Invega (paliperidone) ones, and I find I’m not as dull or muted as on other antipsychotics. I was on strong, typical or atypical antipsychotics for decades, and I’m sort of “waking up” on Abilify Maintena. It’s sorta hard, to start having all these feelings again, when I was sedated for so long, because I have to be able to cope with them, and learn how to live with the feelings instead of blocking them all out. I switched to Abilify Maintena in June 2025, after 3 years on Invega Sustenna/Trinza. My prolacitin was high, Abilify was added, my prolactin went back down, but not enough, so we decided to switch to the Abilify LAI over Invega. I’ve never really been on Abilify before, except briefly over a decade ago, and it’s really quite something! I do have some breakthrough paranoia and hallucinations, but have insight, and my mood is relatively stable. I am still reaching steady state at this time.

    I am on 400mg, IM, q 4 weeks.

    Saphris – Adjunct Antipsychotic And Mood Stabilizer

    Saphris, a 10mg sublingual formation of the atypical antipsychotic asenapine, is added on for breakthrough symptoms like paranoia, hallucinations and insomnia that aren’t managed otherwise with Abilify Maintena. It tastes terrible.

    Saphris is a potent D2 antagonist, which means it rapidly smacks down psychosis and stabilizes mania, it is also an antagonist at 5-HT2A, partial agonist at 5-HT1A and acts on histamine (H1) and alpha-adrenergic receptors.

    Effexor XR – 300mg – Dropped from 375mg

    Effexor XR, velafaxine extended release, is a well known SSRI/SNRI (selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor) that acts as a a SSRI at lower doses (under 225mg) and an SNRI at higher doses. At very high doses it has light actions on dopamine. I’m on it for anxiety and depression – I’ve had ECT twice, once in 2008, once in 2022, and it helped get me out of that, so it stays.

    I’m on a pretty high dose. It can be activating. I’m on the “norepinephrine is going crazy” dose and it’s like chugging coffee without the fun. I’m finding I have afternoon anxiety, when Effexor is commonly prescribed for anxiety – at lower doses.

    Foquest – 85mg – Dropped from 100mg

    Foquest is a long acting release version of methylphenidate, most people know as “Ritalin”. It’s old medicine packed into new technology and is a decent stimulant without a “high” or “crash” later in the day. I find it effective, but it can make me pretty paranoid on bad days, and I have dropped down doses before and probably will again.

    Elavil – 50mg – PRN, kinda

    Elavil (amititriptyline) is a well known tricyclic antidepressant used for just about everything from depression to pain. It’s effective for insomnia, and I’m on it for that in particular. I’ve been on it forever, it has a high anticholinergic load, so I might be switching off it onto something a little “cleaner”.

    Propranolol -The beta blocker that got me off benzos after 23 years.

    I partly stopped taking benzos as a challenge, and partly out of spite. But propranolol has done magic for my anxiety without sedating me and knocking me out the way benzos did. Oddly, my anxiety baseline without valium is much lower than on it. I’m learning how to cope again, and live without benzos. I’m having weird side effects still, one called “residual disequilibrium”, which can feel like being outside of your body, being rocked back and forth on a boat, and like things are happening a second in time difference from you.

    I didn’t know about that when I started tapering benzos, so it was an interesting surprise. It can last months! It’s s steadily going down.

    Propranolol has knocked out my physical anxiety and I don’t get the bursts of my heart racing out of my chest and blood pressure climbing (or crashing) and that really helps with the anxiety symptoms.

    Stability

    I’m kinda on the subthreshold of hypomania, but still have insight. I have some paranoia, the benzo withdrawal, and sensory overload. I’m not sure what exactly is a symptom and what is the Abilify activation, akathisia, and withdrawal, so I’ve been coping and waiting. The next step is replacing Saphris and Elavil with low dose Zyprexa (olanzapine) to knock out the residual paranoia and stabilize my mood. Hopefully that won’t happen.

    Lifestyle stuff

    I’m doing a few things with my lifestyle to help, some are proven, some aren’t. I

    • take fish oils (for my triglycerides, not sure if this helps mood/psychosis)
    • knit all the time, I find it relaxing and helps me with creativity, stress and overthinking
    • make dice – this helps me creatively, and gives me something to focus on and also sell on my time off work
    • only drink one coffee a day
    • smoke a couple cigarettes – I’m not withdrawing from benzos and nicotine at the same time!
    • exercise a bit – I haven’t got my birthday present (stationary bike) up and running yet
    • Do CBT and DBT, I have a couple books and a schedule. It helps reality check the paranoia. It helps me talk back to the hallucinations.

    None of this is medical advice, and don’t take it as any!