Q: I recently requested to be taken off of 5mg xanax qd for 20 years for a ptsd that is now a gad.
the first answer was no! my psychiatrist said he would not do it. reluctantly he sent me to an intensive outpatient clinic where I was switched to valium 2mg tid. I have been on this for 5 weeks.
my question is two-fold. how long will I have heightened senses (visual and auditory) and what is the prognosis/duration for this type of titration? how long before I can be drug free?

thank you


A: Heightened senses is usually an initial withdrawal symptom, one that lasts a few days to a week. Sounds, tastes and smells are greatly magnified. Some of my patients have enjoyed this phase, and some patients have reported that they also have enhanced memory and mental functioning. It is unusual for it to last 5 weeks as your letter suggests.

I am unable to give you information concerning prognosis or duration given your unusual approach to stopping Xanax. My approach would have been to simply taper down the Xanax rather than to convert it to Valium As a rule of thumb, 1 mg of Xanax is about the same as 10 mg of Valium. So, if I were to convert your Xanax to Valium, I would have started you on 30 to 50 mg of Valium a day and tapered down from there.

The speed at which a benzodiazepine is reduced is highly variable and needs to be individualized. I take almost everyone off of their medications, as there is no convincing evidence that long term drug use is necessary. Most of the people taking psychiatric medications long term are doing so because of dependency. Dr. Ashton has Valium tapering protocols that have been useful for many people. Here is the link to her classic protocol: http://www.geocities.com/benzobusters/manual.htm
Ashton's protocol is an example of a very slow tapering. Going slow will minimize withdrawal and possible long term effects. Also, you need a doctor who is familiar with the withdrawal or they will mistake withdrawal symptoms for new illness and start prescribing you more drugs that you really don't need.

I think you need to point blank ask your doctor what his actual experience is with Xanax, because I consider the change to Valium about the same as dropping your Xanax from 5 mg a day to 1.5 mg a day all at once.

What I find odd is that all medical education involves teaching doctors to prescribe drugs but there are almost never any educational seminars to teach doctors how to stop a drug. In this regard, physicians who take people off of prescription drugs are largely self taught.

Let us know how things go. Good luck Kate!


Stuart Shipko, MD (Psychiatrist/Neurologist)
Founder and Medical Director of PDI
The Panic Disorders Institute
Author of Surviving Panic Disorder: What You Need To Know Information provided by Dr. Shipko is general in nature and should not be construed as a substitute for a visit to and examination by your own personal physician.
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