Benzodiazepine Tapering & Deprescribing
in Pompano Beach, FL

Can a Pompano Beach patient come off a benzodiazepine or a psychiatric medication without leaving home?

Yes. Dr. Leeds, an osteopathic physician and a specialist in deprescribing, works from an office in Fort Lauderdale about 10 miles south of Pompano Beach and sees patients across Florida by secure video. The practice’s lead service is tapering benzodiazepines and z-drugs. Its second service, psychiatric medication deprescribing, means coming off antidepressants, gabapentinoids, and antipsychotics, and, in fact, it takes up most of this page because so many patients arrive taking more than one of these medications at once.

Each week there is a video visit with Dr. Leeds himself, often up to an hour, and between visits urgent questions go by text, 24/7. Prescriptions travel electronically to a pharmacy near the patient. A liquid or compounded dose, when needed, comes from a Florida compounding pharmacy that ships to the door.

Pompano Beach is a coastal city in northeastern Broward County, between Fort Lauderdale to the south and Deerfield Beach to the north. This page also serves Lighthouse Point, Deerfield Beach, Coconut Creek, Margate, and Coral Springs, and the care is the same near the beach, west of Federal Highway, or out by I-95 and Florida’s Turnpike.

Why do so many people in Pompano Beach arrive taking several psychiatric medications at once?

Because each one was added by a different doctor at a different time, and nobody planned the way out. A typical history starts with a benzodiazepine such as Xanax (alprazolam) or Klonopin (clonazepam) for anxiety years ago. An SSRI, a selective serotonin reuptake inhibitor such as Lexapro (escitalopram), Zoloft (sertraline), or Paxil (paroxetine), is added later, then gabapentin for nerve pain or sleep, then a low bedtime dose of Seroquel (quetiapine) when sleep got worse anyway, and perhaps Ambien (zolpidem) on top. So, years later, together, they are a burden no single prescriber feels responsible for.

Some patients arrived in Florida with prescriptions that a new doctor continued because stopping them looked risky. Unfortunately, few physicians learn how to stop these medications, so the person who asks is told to halve the dose for two weeks, or to keep taking them. And, for an older adult the stakes are higher, because benzodiazepines and sleep medications raise the risk of falls and confusion.

None of this is a character flaw. If you take a medication every day, your brain adapts to it, and when the medication is reduced faster than the brain can readapt, withdrawal symptoms appear. That adaptation is physical dependence. Physical dependence is not addiction, which is compulsive use despite harm, a pattern most patients who come for a taper have never shown.

What is antidepressant discontinuation syndrome, and why is it mistaken for the return of depression?

SSRIs and the SNRIs, the serotonin-norepinephrine reuptake inhibitors such as Effexor (venlafaxine) and Cymbalta (duloxetine), change how the brain handles serotonin, and the brain adjusts over months of daily use. When the dose drops faster than it can readjust, the result is discontinuation syndrome: dizziness, the brief electric-shock sensations patients call brain zaps, nausea, insomnia, irritability, flu-like aches, and surges of anxiety. With a short-acting drug such as paroxetine or venlafaxine, symptoms can begin within a day or two of a missed dose. Yet, with fluoxetine, which lingers for weeks, they arrive late and get blamed on something else.

The labels approved by the U.S. Food and Drug Administration (FDA) for these medications list these symptoms and advise gradual reduction rather than an abrupt stop. Unfortunately, what usually happens is different: the symptoms are read as the depression or anxiety coming back, the medication is restarted, and the patient is told the failed attempt proves the drug is needed for life. It proves nothing of the kind. The two can usually be told apart. Discontinuation symptoms start within days of a dose change, while a true return of depression builds over weeks. Dizziness, brain zaps and nausea are not symptoms of depression. And, discontinuation symptoms ease within a day or two of restoring the previous dose, which depression does not.

The Maudsley Deprescribing Guidelines apply the same principle to antidepressants as to benzodiazepines: the relationship between dose and effect on the brain is hyperbolic, so the last few milligrams carry far more effect than the first few, and the steps must shrink as the dose falls. Fortunately, the Guidelines also say what to do when withdrawal becomes intolerable: hold the current dose longer, or return to the last dose at which symptoms were tolerable. That is how Dr. Leeds works. A taper off of an antidepressant taken for years is measured in months, sometimes longer, never in a two-week cut.

Is gabapentin or pregabalin withdrawal real, and how are they tapered?

Yes. Gabapentin (Neurontin) and pregabalin (Lyrica), the gabapentinoids, are prescribed in Pompano Beach for nerve pain, sleep, anxiety, and restless legs, often off-label, and they are widely thought harmless to stop. They are not. In fact, after months of regular use, a sudden stop can bring anxiety, insomnia, sweating, a racing heart, nausea, restlessness, and a flare of the very pain the drug was treating, and seizures have been reported after high doses were stopped abruptly. The FDA label for pregabalin lists insomnia, nausea, headache, anxiety, and sweating after abrupt or rapid stopping and advises a gradual taper.

The taper is gradual, each step smaller than the last, with a liquid once tablets or capsules become too coarse. For severe gabapentinoid withdrawal, the Maudsley Deprescribing Guidelines advise going back up to the last dose at which the patient was stable and then halving the rate of reduction, or slowing it even further.

Dr. Leeds typically does not add gabapentinoids to make a benzodiazepine or other psychiatric medication taper easier, and in general he avoids adding any new medication that will need a taper of its own because of physical dependence. When a taper gets hard, the first moves are a hold, a slower rate, or a small physician-guided increase back to a tolerated dose, not a second dependence-forming drug. Of course, if a seizure, chest pain, or thoughts of self-harm appear, the taper waits: those call for 911 or the nearest emergency room, and for suicidal thoughts the 988 Suicide and Crisis Lifeline answers calls and texts.

What about quetiapine prescribed off-label for sleep?

Seroquel (quetiapine) is an antipsychotic, and at the low bedtime doses given for insomnia its sedating effect comes largely from its antihistamine action. Yet, the medication’s own label notes that insomnia, nausea, and vomiting have been reported after abrupt discontinuation, and patients also describe sweating, restlessness, and insomnia worse than before the drug was started.

Dr. Leeds tapers these medications gradually for Pompano Beach patients who have no clear ongoing reason to take them. With antipsychotics, antidepressants, and gabapentinoids, his work runs in one direction only: toward a lower dose and, where that is right for the patient, none. As a rule he does not start these medications, and he avoids prescribing them to blunt withdrawal from another drug. Because the tablets come in a few fixed strengths, the small steps near the end usually call for a compounded liquid or precisely dosed capsules.

Why does Dr. Leeds taper one medication at a time?

Because a nervous system adjusting to one change can be read, and one adjusting to three cannot. When a benzodiazepine, an antidepressant, and a gabapentinoid are all reduced in the same month, nobody can tell which drug is producing the insomnia or anxiety that follows, and the usual response is to restart all of them. However, with one medication moving and the others held steady, a symptom has a likely source, and the adjustment is precise: a smaller step, a hold, or a return to the last tolerated dose of that one drug.

So, the order is planned for the individual at the consultation, with the whole medication list on the table from the start, so the later tapers are part of the plan rather than an afterthought. More on the method is on the psychiatric medication deprescribing page.

How does the benzodiazepine taper itself work, and where do the liquid doses come from near Pompano Beach?

Benzodiazepine tapering remains the lead service and is often the first taper on a Pompano Beach patient’s list. Dr. Leeds tapers Xanax, Klonopin, Ativan (lorazepam), and Valium (diazepam), and the z-drugs Ambien and Lunesta (eszopiclone), which come off by the same rules. His usual route is the Ashton Manual crossover described by the late Professor C. Heather Ashton: a short-acting benzodiazepine is gradually replaced by diazepam, and the diazepam is then reduced in hyperbolic steps that shrink as the dose falls. A benzodiazepine taper usually takes a year to 18 months and sometimes longer, and the patient’s symptoms set the pace. The 2020 FDA update to the boxed warning on every benzodiazepine states that physical dependence can develop even with use as prescribed, and that stopping suddenly or cutting fast can bring on withdrawal reactions, including seizures, that can be life-threatening. Hence, beyond roughly four weeks of regular use, a benzodiazepine is tapered, never stopped abruptly.

The small steps near the end require a dose that can be measured precisely. A manufactured diazepam oral solution, 1 mg/mL, exists with its own FDA label. The chain and local pharmacies in Pompano Beach rarely keep it on the shelf. Fortunately, they can usually order it, so the prescription goes in ahead of the step that needs it. The usual end point on that solution, in Dr. Leeds’ practice, is about 0.1 mg rather than the 0.5 mg stop the Ashton Manual describes, which remains an option. The Ashton schedules phase out the night-time dose last, and a small physician-guided increase along the way is a legitimate move, not a failure.

A manufactured liquid exists for some SSRIs and for gabapentin but not for every drug on the list. Where none exists, or where the steps must be smaller than any tablet allows, a Florida compounding pharmacy prepares a liquid or exact-dose capsules and ships them to a home in Pompano Beach or Coral Springs. None of the numbers on this page is a schedule for anyone to copy. More is on the benzodiazepine tapering service page.

What is BIND, and does it appear during antidepressant tapers too?

BIND, short for benzodiazepine-induced neurological dysfunction, names the symptoms a benzodiazepine can produce at a steady dose, during a taper, and after the last dose: surges of adrenaline unrelated to the original anxiety, a racing heart on standing, air hunger, burning skin, sensitivity to sound and light, and a fog over memory and concentration. When it begins at an unchanged dose, the state is called tolerance withdrawal. When it persists for months after the last dose, it is protracted withdrawal, which generally improves with time in the pattern patients call windows and waves.

Additionally, antidepressant and gabapentinoid withdrawal overlap with BIND, so a patient reducing more than one medication over a year has symptoms from more than one source, another argument for one taper at a time. Dr. Leeds treats the conditions that travel with BIND rather than referring them out, and a bad week is information: slow down, hold, or shrink the step. The BIND guide explains the syndrome in depth, and the receptor-level science has a page of its own.

What does concierge telemedicine look like from Pompano Beach?

It means the same doctor at every visit. Dr. Leeds runs a concierge practice outside the insurance system, with no call center, coach, or substitute physician in between. A spouse, an adult child, or an advocate is welcome at any visit, and never required. Care begins with a consultation.

Pompano Beach is close enough that in-person visits are a real option. The Fort Lauderdale office, at 3290 NE 33rd Street, is about 10 miles and 20 to 30 minutes down Federal Highway (US-1) or I-95, with in-office hours Monday to Friday, 10 AM to 2 PM. One common pattern is a single in-office visit at the beginning, with every visit after that by video. And, plenty of patients never make the drive at all.

Of course, a coastal city also plans for hurricanes. When an evacuation or a storm disrupts a taper, holding the dose is preferred over cutting, because the stress of the emergency is enough on its own, and it is good to keep a reserve of medication on hand for natural disasters so that a taper never turns into an abrupt stop.

What else does Dr. Leeds treat for patients in Pompano Beach?

For opioid dependence, Dr. Leeds prescribes buprenorphine, which is the medication inside Suboxone and ZubSolv and the generic films and tablets that pair it with naloxone, to patients in Florida by telemedicine. Visits for buprenorphine are monthly, and weekly when needed. Long-acting injectable forms can be asked about at a consultation. For alcohol use disorder the tool is the Sinclair Method: naltrexone goes in about an hour ahead of the first drink, and over months the reward from alcohol fades and so does the drinking, with nobody asked to be abstinent before starting. Other substance problems are discussed at a consultation, which decides whether Dr. Leeds can help. Low dose naltrexone, from a compounding pharmacy, is offered as well for autoimmune-related pain conditions.

Dr. Leeds has more than 26 years of experience in family medicine. He has treated medication and drug dependence and addiction for over two decades, and he advises the Benzodiazepine Information Coalition, a nonprofit devoted to benzodiazepine dependence and withdrawal, as a member of its medical advisory board.

Frequently asked questions

Can Dr. Leeds help a Pompano Beach patient taper medications other than benzodiazepines?

Yes. Alongside benzodiazepine and z-drug tapering, Dr. Leeds helps patients come off of SSRIs, SNRIs, gabapentin and pregabalin, atypical antipsychotics such as quetiapine, and other psychiatric medications that produce withdrawal when stopped too quickly.

What is SSRI discontinuation syndrome?

It is the set of symptoms that follows a too-fast reduction or an abrupt stop of an SSRI: brain zaps, dizziness, nausea, insomnia, irritability, flu-like feelings, and emotional swings. It is often mistaken for the return of the original depression or anxiety, and the medication is restarted when a slower taper was needed.

Why does Dr. Leeds taper only one medication at a time?

When several medications are reduced together, nobody can tell which one is causing the symptoms that follow. Holding the others steady while one moves makes the source clear and the adjustment precise, and it is safer and more comfortable for the patient.

Is gabapentin withdrawal real?

Yes. Regular use of gabapentin produces physical dependence, and stopping suddenly can cause anxiety, insomnia, sweating, nausea, pain, and in some cases seizures. It is tapered gradually with a physician, never dropped, and Dr. Leeds does not add it to ease a different taper.

Can quetiapine taken for sleep be tapered, and how long does that take?

Yes. A low dose taken for years still needs a gradual taper, usually with a compounded liquid or capsules for the last steps, because rebound insomnia and nausea follow an abrupt stop. The time depends on the dose, the years of use, and the patient’s response. Months is a reasonable expectation.

Does a Pompano Beach patient have to drive to Fort Lauderdale for visits?

No. Visits are by video, prescriptions go to a pharmacy in or near Pompano Beach, and compounded doses ship to the home. The office is about 20 to 30 minutes away by Federal Highway or I-95 for anyone who prefers a first visit in person.

Residents of Pompano Beach, Lighthouse Point, Deerfield Beach, Coconut Creek, Margate, and Coral Springs who want to come off of a benzodiazepine, a sleep medication, an antidepressant, or another psychiatric medication, one at a time, can request a consultation through the contact form. Contact the office today.

This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.