Benzodiazepine Tapering & Deprescribing
in Tampa, FL

Can you taper off of a benzodiazepine in Tampa without leaving home?

Yes. Dr. Leeds sees patients throughout Florida by secure video, and a patient in Tampa, St. Petersburg, or Clearwater gets the same unhurried visit as a patient sitting in his Fort Lauderdale office. The taper happens at your own kitchen table, with no bridge to cross and no waiting room.

In short:

• Dr. Leeds tapers benzodiazepines for patients in Tampa by secure video. His office is in Fort Lauderdale, and he prescribes for patients in Florida.
• Visits are weekly, often up to an hour, with 24/7 text access between them, and every visit is with Dr. Leeds himself.
• The taper usually begins with a gradual crossover to diazepam (Valium), following the Ashton Manual, then slow reductions that get smaller as the dose falls, with liquid doses when a tablet is too coarse.
• Physical dependence is not addiction, so there is no rehab program. The pace follows the patient’s symptoms, with holds when needed, and a taper often takes a year to 18 months or longer.

Many of the people who find this page were prescribed Xanax, Klonopin, Ativan, Valium, or Ambien by a doctor, took it exactly as directed, and now cannot lower the dose without getting sick. That is physical dependence, the nervous system adapting to a medication it was told to expect every day.

In fact, many people who come to Dr. Leeds for a benzodiazepine taper are not addicted to anything. They were injured by a prescription, which is why the treatment is a slow medical taper and not an addiction program. So, why do so many tapers fail, and what does a taper look like when the pace is set by your symptoms instead of by a calendar?

Why do so many benzodiazepine tapers fail?

Unfortunately, the usual taper is written on a calendar before the first dose is cut. The dose drops by the same amount on the same day every other week, whether or not you slept, and whether or not your heart was pounding at 3 a.m. The calendar does not know how you are doing.

A taper that ignores symptoms fails in one of two directions. Either you go back up to the original dose and feel like you failed, or you push through and end up in a Tampa emergency room with a chart that says “anxiety.” Stopping cold turkey is the extreme case of the same mistake.

It is common for a patient to arrive at a first visit having already tried more than once: a prescriber who cut the dose in half and said to come back in a month, or a program that promised to finish the job in ten days. That is not a willpower problem. It is a schedule problem.

Yet, the failed attempts are not harmless practice runs. Each rapid withdrawal can make the next one harder, a pattern known as kindling, so the nervous system reacts more strongly to the same cut the second and third time around. A fast taper is not a strong one.

One warning stands above everything else: never stop a benzodiazepine suddenly, and never let a taper turn into an abrupt stop. Sudden discontinuation can trigger seizures and can be life-threatening. A seizure is a medical emergency, and the right response is a call to 911. For thoughts of suicide, call or text 988, the Suicide and Crisis Lifeline. However a taper is shaped, it should be gradual and medically supervised.

What does a symptom-guided taper actually look like?

Imagine driving across the Howard Frankland Bridge in a summer afternoon storm. You do not set the cruise control and take your hands off the wheel. When the rain gets heavy, you slow down, and when it clears, you pick the speed back up, and St. Petersburg is still exactly where it was.

A symptom-guided taper works the same way. The dose is the speed, the symptoms are the weather, and the destination never moves. While this is not a perfect analogy, it explains why Dr. Leeds does not hand a patient a schedule and disappear for a month.

The taper starts with stabilization, because a nervous system that is already in withdrawal is not ready for a cut. Then comes a small reduction, and then a week or two of watching. If the week goes well, the next step may follow, and if symptoms spike, the doctor must slow down, hold, or make the next step smaller, and the patient may ask for any of those at any time.

Symptoms are information, not failure. When a cut turns out to be too big, that is the nervous system reporting the weather, and the report is used to adjust the plan. There is no one-size-fits-all schedule, which is why Tampa patients see Dr. Leeds by video every week and can text him between visits. The schedule is whatever your nervous system will tolerate this week.

What is the Ashton Manual, and what is hyperbolic tapering?

The Ashton Manual was written by Professor C. Heather Ashton, a British clinical psychopharmacologist who ran a benzodiazepine withdrawal clinic for many years. Her central method is the crossover taper, where a patient switches from a short-acting benzodiazepine such as Xanax (alprazolam) or Ativan (lorazepam) to diazepam (Valium), which leaves the body slowly and smooths out the ups and downs between doses.

Dr. Leeds prefers the crossover. In his experience, patients who taper on diazepam have a more comfortable taper and keep functioning better at work and at home. Of course, diazepam does not suit every patient, and when metabolism or a bad reaction rules it out, he tapers the current medication instead, with a crossover to Klonopin (clonazepam) as the usual alternative for Xanax.

Hyperbolic tapering is the other half of the method. The effect of a benzodiazepine on its receptors is not a straight line, so a cut that was barely noticed at a high dose can be a shock at a low one, which is why the steps get smaller as the dose comes down. The Maudsley Deprescribing Guidelines set out this approach for benzodiazepines, for z-drugs such as Ambien (zolpidem), which act on the same receptors, and for antidepressants and gabapentinoids.

Small steps need small doses, and a tablet cannot be broken into a reliable crumb. So, Dr. Leeds works with compounding pharmacies for liquid formulations that allow reductions of a fraction of a milligram, and a manufactured diazepam oral solution is available at retail pharmacies as well. A taper done this way often takes a year to 18 months or longer, and some take several years. Nobody, including Dr. Leeds, can tell you its length in advance.

What is BIND, and is benzodiazepine withdrawal permanent?

BIND, or benzodiazepine-induced neurological dysfunction, is the name for the cluster of symptoms that can appear during and after a taper, and sometimes before one, as tolerance develops at a steady dose. Burning skin, air hunger, a racing heart, ringing ears, a gut that will not settle, rage that frightens the person feeling it, and a fog that makes reading impossible can all belong to it. They look like a dozen illnesses, and they are one destabilized system with many branches.

Is it the anxiety coming back? Is it a new disease? Or, is it the medication leaving? Very often it is the third, and knowing that is part of the treatment, because fear keeps the stress system switched on and makes every symptom louder.

Is it permanent? Usually it is not, but after months of symptoms that come and go it can feel that way. Recovery usually arrives as windows and waves, good stretches that get longer and bad ones that get shorter. The nervous system is not broken. It is healing, on its own timeline, and no doctor can promise the date.

Unfortunately, many Tampa patients have already been told that these symptoms are “just your anxiety coming back.” That dismissal is its own injury, and it comes from the same profession that wrote the prescription and said it was safe. In September 2020, the U.S. Food and Drug Administration, or FDA, updated the boxed warning on every benzodiazepine to spell out physical dependence, withdrawal reactions that can last for months, and the need for a gradual, patient-specific taper, which is a useful page to bring to a doctor who does not believe you.

Dr. Leeds treats the medical problems that travel with BIND, including the histamine-type reactions, the heart-rate swings, and the air hunger, rather than referring each one out. Protracted withdrawal, meaning symptoms that persist for months or years after the last dose, gets the same care.

Does Dr. Leeds also taper antidepressants, gabapentin, and antipsychotics?

Yes. The second half of the practice is psychiatric medication deprescribing: the SSRIs, or selective serotonin reuptake inhibitors, such as Lexapro (escitalopram), Zoloft (sertraline), Prozac (fluoxetine), and Paxil (paroxetine), the SNRIs, or serotonin-norepinephrine reuptake inhibitors, the gabapentinoids gabapentin (Neurontin) and pregabalin (Lyrica), and antipsychotics such as Seroquel (quetiapine), Zyprexa (olanzapine), and Abilify (aripiprazole). Seroquel and Zyprexa are often handed out for sleep, and the dependence that follows surprises everyone, including the prescriber.

To be clear, Dr. Leeds tapers these medications. He does not treat with them, and he does not start anyone on them. The practice’s whole relationship with these drugs is getting people off of them.

The same tools apply: hyperbolic steps, the Maudsley Deprescribing Guidelines for the antidepressants and gabapentinoids they cover, compounded liquid doses where a tablet is too coarse, and one medication at a time, so that when a symptom appears everyone knows which drug caused it. While two drugs can sometimes be reduced in the same year, they are not reduced in the same week.

Stopping an SSRI too fast brings brain zaps, dizziness, nausea, and a flood of emotion that is routinely mistaken for the original depression coming back, so the drug gets restarted for the wrong reason. And, gabapentin withdrawal is real, with anxiety, sweating, pain, and in rare cases seizures. A slow taper turns most of that into something a patient can live with.

Do you need a rehab or a detox to get off of a benzodiazepine?

Search for benzodiazepine help in Tampa and the results are mostly detox centers and residential programs. They were built for addiction, and their calendars are set by what insurance will pay for, which is usually a week, ten days, or a month. The pool in the brochure is real. So is the discharge date.

A benzodiazepine taper that needs a year cannot be finished in thirty days, so the program finishes it anyway. The result is a fast taper, a discharge labeled “substance free,” and a patient back home in Brandon or Wesley Chapel who restarts the medication within weeks, now with a rehab stay on the record and a nervous system that has been kindled once more.

Some people may need a higher level of care.

Fortunately, for everyone else, the outpatient taper is the medicine. You stay home, keep your job, and reduce over months at a pace you can tolerate, with a doctor adjusting the plan as you go. The schedule follows your nervous system, not an insurance benefit.

What about opioids, alcohol, and other dependence?

Dr. Leeds also treats opioid dependence with buprenorphine, including Suboxone, ZubSolv, and their generics, by telemedicine for patients in Florida. Induction is done at home with phone support, with a low-dose start when needed, as is often the case with fentanyl, and visits are monthly, or weekly when needed. Buprenorphine without naloxone, the tablet formerly sold as Subutex, is used when there is a medical reason for it, such as pregnancy.

For alcohol use disorder, the practice offers the Sinclair Method: naltrexone taken about an hour before drinking, so that the reward alcohol normally delivers is blocked and the habit fades over months through a process called pharmacological extinction. It does not require you to stop drinking before you start. Supervised alcohol withdrawal at home, with a nurse on site around the clock, is also available for patients who need it.

Questions about other drugs, including stimulants, are answered at a consultation rather than promised on a web page, because there is no medication for stimulant addiction and whether Dr. Leeds can help depends on the person. Low dose naltrexone for certain autoimmune pain conditions is a small side of the practice as well.

How does concierge telemedicine work from Tampa Bay?

Dr. Leeds runs a concierge practice, which means it is not an insurance-based clinic and the time is his to give. Taper patients have a video visit every week, often up to an hour, and they can text him with an urgent question on any day.

That is what makes a year-long taper possible. There is no coach, no nurse practitioner, and no covering doctor. Every visit is with Dr. Leeds.

Geography matters in Tampa Bay. Hillsborough and Pinellas are separated by water, and a specialist on the far side of the bay can cost an afternoon. Yet, by video, a patient in St. Petersburg, Clearwater, Brandon, Wesley Chapel, Riverview, or Largo is as close as one in Fort Lauderdale, and the Fort Lauderdale office is there for anyone who would rather be seen in person.

What if your Tampa doctor will not help you taper?

This is one of the most common reasons people find this page. The prescriber who started the medication is not comfortable supervising a taper that runs a year, offers only to stop it over a few weeks, has retired or stopped prescribing controlled medications, or simply says the symptoms are in your head.

Dr. Leeds sees patients in exactly this situation. The first appointment goes over your current prescription, how long you have taken it, the dose you are on now, and every attempt you have made to reduce it, and the taper begins from wherever you are.

Questions Tampa Bay patients ask

Does Dr. Leeds have an office in Tampa?

No. While the only office is in Fort Lauderdale, Tampa Bay patients are seen by secure video, and the visit is the same length with the same doctor either way. An in-person appointment in Fort Lauderdale is available to anyone who wants one.

Can a Tampa pharmacy fill a liquid taper?

Compounded liquid formulations come from a compounding pharmacy that Dr. Leeds works with, and the manufactured diazepam oral solution can be ordered through major retail pharmacies in the Tampa area. Switching brands or manufacturers mid-taper can unsettle a sensitized nervous system, so any switch at the pharmacy counter is worth a message to Dr. Leeds the same day.

What happens if a cut goes badly?

You hold, and you let Dr. Leeds know. A symptom spike after a reduction means the step was too large or too soon, so the next step is delayed, made smaller, or the dose is held until things settle. A seizure, or any symptom that feels like an emergency, is a 911 call, not a text message. Holding is not a setback, and it is never treated as one.

Do I have to stop my benzodiazepine before the first appointment?

No, and please do not. Stopping suddenly is the one thing this page asks you never to do. Come to the first visit on your current dose, with your prescription bottle and your history, and the taper starts from there.

Is a consultation the same as becoming a patient?

No. A consultation is a conversation about your situation and your options, and it does not by itself create a doctor-patient relationship. Some people use it to get a second opinion on a taper they are doing elsewhere, and others continue on as patients. Either is fine.

About the physician

Dr. Leeds is an osteopathic physician with over 26 years of experience in family medicine and over two decades of experience treating medication and drug dependence and addiction. His practice is focused on benzodiazepine and z-drug tapering and psychiatric medication deprescribing. He serves on the medical advisory board of the Benzodiazepine Information Coalition and hosts The Rehab Podcast on the Mental Health News Radio Network. He sees patients at his Fort Lauderdale office and by telemedicine throughout Florida.

How do you get started from Tampa?

Tampa Bay residents who want a supervised benzodiazepine taper, help coming off of a psychiatric medication, or a second opinion on a taper already underway can contact the office through the contact form to schedule a consultation. Appointments are by secure video from anywhere in Florida, or in person at the Fort Lauderdale office.

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.