Dr. Ashton (Chrystal Heather Ashton) is frequently noted as "the" leading expert on benzodiazepines-- depending on who you ask, of course. "In the online benzo world", you'll find about 95% of the online population thanking her. The other 5% thinks that benzo.org.uk, from where she first introduced "The Ashton Manual" is too anti-medicine, with an agenda.
Dr. Ashton graduated from Oxford University with a Bachelor's (US)/Honor's (UK) Degree in Physiology in 1951. She gained her MD (US)/DM (Doctor of Medicine, UK) degree in 1956. She has been a professor at the University of Newcastle upon Tyne in the UK since 1965, as a "researcher and clinician". According to http://www.benzo.org.uk/manual/bzcha00.htm#3:
"Her research has centred, and continues, on the effects of psychotropic drugs (nicotine, cannabis, benzodiazepines, antidepressants and others) on the brain and behaviour in man. Her main clinical work was in running a benzodiazepine withdrawal clinic for 12 years from 1982-1994.I have no idea what a degree in Physiology actually means now, or meant in 1951. It's the study of the human body, of course, and I'm not sure if the UK has/had different branches of the study, as the US does. In the US, one would have a title based on their education specialty, ranging from Neurologist, Cardiologist, to Dermatologist and so on. Maybe it didn't matter in 1951 when Dr. Ashton obtained this degree. I wouldn't know-- I'm not from the UK, nor do I know how their educational degree system operates. I also can't explain why the UK claims to (or might indeed) have a Valium "problem". For whatever reason, it's hardly ever prescribed in the US. I blame false and 40 year old biases against it. In my opiion, it doesn't bother me too much. One can obtain Valium from an MD if they want. The MD would ask "Why?", not because of it's old bias, but it's potency, unless you're tapering, and even then, they would still ask "Why?".
She is at present involved with the North East Council for Addictions (NECA) of which she is former Vice-Chairman of the Executive Committee on which she still serves. She continues to give advice on benzodiazepine problems to counsellors and is patron of the Bristol & District Tranquilliser Project. She was generic expert in the UK benzodiazepine litigation in the 1980s and has been involved with the UK organisation Victims of Tranquillisers (VOT). She has submitted evidence about benzodiazepines to the House of Commons Health Select Committee."
Feel free to Google Dr. Ashton. You will find the term "the leading expert on benzodiazepines" quite often. This is fine; these are opinions that others have of her. She ran a benzodiazepine withdrawal clinic in the UK, as stated above, for 12 years, between 1982-1994. Dr. Ashton wrote a book titled "Benzodiazepines: How They Work and How to Withdrawal", apparently published in 2001 by the same university she taught at, according to Google Books, yet its copyright date begins in 1999, according to http://www.benzo.org.uk/manual/bzcha00.htm#1. It's been only very mildly revised a few times, usually in the form of a short forward by Ashton and that's the onlly changes made to the AM as far as I can tell. There is also "The Ashton Manual Supplement", published in 2011.
I always thought using the word "manual"to describe a book about a pharmaceutical medication was very strange. Manuals should be used for cars and washing machines-- not medications and their effects on the brain. At first I thought it was just slang for the actual book, as benzo.org.uk has it noted as "aka The Ashton Manual". There appear to be few different covers for the book. One, which is totally blue in color and says "UK version", is sadly not dated, but it does not say "Aka The Ashton Manual" while the other two do. I have heard that there were some issues about who would "own" it, host it, etc. I have never gotten a concrete answer to this question, and I have no idea why some covers differ in their titles.
The last time I was "Anti-Ashton", one reader claimed they didn't know if they were reading the Cesspool Of Madness or my blog. I didn't find it very funny. I said I considered her "research" biased, flawed from the start, and more or less-- "garbage" and "probably has caused at least one suicide using the law of large numbers". I didn't say it actually did; I said it probably has, and I used one of Ashton's own "study" with 50 patients, one of whom committed suicide. I never said the cause was directly from using "The Ashton Method". I never could, and I ever would. (And again, if I found myself struggling to reduce 1 mg of Valium per YEAR, and it was the only thing on my mind and it incapacitated me, I can easily see how suicide would be considered in that state.)
If she's such an expert, why is that no pdoc or Neurologist I have asked have never heard of her? Hmm.
So Ashton is a topic once more, along with BB (but not so much BB-- they can't control what members post-- as long as it's not "inflammatory" anyways). Mike59 took a screen shot of a BB page where a member alleged to have emailed Dr. Ashton, which Ashton allegedly replied to. I have no way of knowing if either are true either. The screen shot is @ http://i.imgur.com/TPA1e.jpg and the direct link to the BB page is http://www.benzobuddies.org/forum/index.php?topic=67122.0. If this is in fact Dr. Ashton's reply, it would be very reckless for an MD, retired or not, to tell someone they've should stop taking their Seroquel and Prozac. Seroquel is prescribed for a number of reasons. Maybe this person needed it as an actual "anti-psychotic" and not for its (doubtful to even work, IMO) off-label reasons? Does Dr. Ashton know the person's psychiatric diagnosis (assuming this email is even real)? The OP claimed in the email to Ashton that the person was diagnosed with Psychotic Depression, or Major Depression with psychotic features. This would make sense with the Seroquel and Prozac med list. I'd have to agree with the pdocs-- dropping from 10-14 mgs of Valium down to 6 mgs would not logically cause psychotic features to just "appear". That's between a 4 mg and 7 mg cut, it's not that huge of a "cut" to begin with, and it's very doubtful that it had any role in any psychotic episode(s). And whoa! 600 mgs of Seroquel? That alone tells us that this is probably bipolar or severe major depression-related mania or schizophrenia, and not as an "add on" medication for depression or anxiety. Those dosages are usually in the 25 mg- 50 mg range, not 600 mgs.
Here's Dr. Ahston's public/University email address and phone number. Feel free to call and/or email her:
email@example.com; Telephone: +44 (0) 191 256 3325
I don't know what to say, since I even can't say if this is a real email or not. It's terrible advice if it is real. I also get the feeling that it's easier to blame a medication than to accept a MI diagnosis. This is akin to mental illness denialism, and I can't stand that. I SUPER dislike it, because most MI's are very manageable-- and blaming a medication is only adding to the stigma, which I thought we were all trying to get rid of. If Dr. Ashton's reply is real... Of course MDs "should know" and DO know that abruptly stopping or reducing a benzo use can be dangerous. But this has limits, and for good reason. If you tell an MD or pdoc that you're having issues dropping a single mg of Valium (or less), of course they're going to think it's somatic-- and they're not being jerks, nor does it make them not "benzo-wise". If you happen to have an MD that agrees with this and happens to go along with you, and gives you some wackadoo compounding pharmacy clearance-- I'm guessing that they have you labeled as a hypochondriac, and if you want to drop 1 mg of Valium per month, it can't "hurt" you, so why not? They probably have a baby with GI issues who isn't absorbing vitamins and fluids in the next room, and they need to figure out if it's a simple fix that they can do, or if they need to make a referral to a GI specialist ASAP. Sorry, but that's a lot more important than someone who thinks that dropping 1 mg a month of V is causing anything significant, if at all. Sure, it's enabling you in a way, but they realize that you're probably not going to take their advice anyways, and since it can't hurt you, who cares? If you don't believe me, ask to see his/her actual notes (the ones taken right after they see you) sometime. You'll be shocked at what you see.
Sorry (Seth), but I cannot apologize for my opinions on Dr. Ashton-- with or without this BB email even being an issue. Please take a look at http://www.benzo.org.uk/ashdurham.htm. I just came across it and had to take a double look to see who actually said this. It's a speech she made May 18, 2007. Here are a few quotes from it:
So it is the drug company chemist or pharmacologist who decides for what indication the drug will be developed. If the indication is not there, it must be created - in other words a disease suitable for the drug must be invented.
One of the many examples of this process was the development in the 1970s of Xanax (alprazolam), a very potent benzodiazepine, for panic disorder. The marketing of this drug involved a clear strategy to take advantage of the medical profession's current confusion about the classification of anxiety disorders and to create a perception that the drug (Xanax) had special and unique properties that would capture a market share of benzodiazepines that would displace diazepam (Valium) from the top position. There was in fact nothing unique in this regard about Xanax. All the benzodiazepines including Valium were good for panic attacks.
Meanwhile alongside the development of Xanax, the confused psychiatrists were working on a new classification of anxiety disorders. Panic disorder (invented by the makers of Xanax) became a new separate anxiety state in the new Diagnostic and Statistical Manual (DSM III) published by the American Psychiatric Association in which, incidentally, 60-100% of the panel members had financial ties to the drug companies and today anxiety is still split into separate categories which include panic disorder, agoraphobia, social phobia, other specific phobias and generalised anxiety disorder. But of course people with generalised anxiety get panics and develop agoraphobia and people with panics have generalised anxiety and other phobias.
But the similarity between benzodiazepines and barbiturates was ignored and doctors were urged to prescribe benzodiazepines. They complied with such zeal that benzodiazepines became for a time the most commonly prescribed drugs in the world. They were greatly helped by Hoffman-La Roche who attacked barbiturates in order to sell their first benzodiazepines Librium and Valium.
Not to be outdone, the drug companies rapidly produced a series of drugs that were not chemically benzodiazepines but produced the same effects. These were the Z-drugs zopiclone, zolpidem, zaleplon and now eszopiclone (Lunesta). They were marketed as sleeping pills but in fact have similar properties to benzodiazepines. They lead to dependence and, like benzodiazepines, cause a withdrawal syndrome. Yet 4-6 million of these are at present prescribed in the UK each year.
With the declining popularity of the benzodiazepines came a renewed interest in antidepressant drugs which led eventually to the SSRIs (selective serotonin reuptake inhibitors) - that we have today. It started as a deliberate tactic to displace benzodiazepines from the market. Drug companies sponsored large international symposia attended by 100s, sometimes 1000s, of physicians where speakers warned of the harm benzodiazepines were doing because of dependence and suggested that serotonergic drugs would work not only for depression but were also good anti-panic drugs and good in generalised anxiety, social phobia and even in post-traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD).
Thus Prozac came on the scene and was so successful that five different drug companies vied to corner some of the market with "me-too" SSRIs that are cheaper to make. Calculations showed that if a drug company could get just 20% of the Prozac market it could make 400-500 million dollars a year with very little investment in research and development. The outcome of this is that we now have 5 other SSRIs in addition to Prozac including paroxetine, sertraline and others.
As mentioned before, the benzodiazepines had been accepted as being dependence-producing, or addictive, on the basis of their withdrawal effects. Now there were clear withdrawal effects from SSRIs. In a scramble to prove that SSRIs were not addictive, psychiatrists actually changed the definition of drug dependence. Criteria for substance dependence were altered in the 1994 DSM IV by the American Psychiatric Association. In this edition, withdrawal effects alone were not enough. A patient now also had to have evidence of tolerance, dose escalation, continued use despite efforts to stop and other characteristics to qualify for dependence. And the withdrawal syndrome was replaced by the patronising euphemism "discontinuation reaction". As if a patient would think there was some subtle difference between "discontinuation" and "withdrawal".
I can't help feeling there is something Orwellian in these manipulations like the slogan in George Orwell's Animal Farm which started as "4 legs good; 2 legs bad" but when pigs started walking on their hind legs like men, the slogan was changed to "2 legs good; 4 legs bad". Or the addition to another slogan "All animals (or withdrawal effects) are equal - but some animals (e.g. pigs or discontinuation effects) are more equal than others".
So it seems that Big Pharma is slowly strangling the medical profession, like ivy growing up a tree, and forcing medical complicity with drug company aims, resulting in new definitions of dependence and even new classes of mental illness. How has the industry obtained this insidious stranglehold on the profession?
What the hell? You'd think those were Breggin quotes, but they were Heather Ashton's.... And I better not get any emails saying these comments/entire speech were "merely off the cuff" comments.You know what? Fuck Dr. Ashton and the lunatic horse she rode in on. No, you're NOT reading the CoM. This is the first time I've read the above speech, and I don't care what others think of my opinions regarding Dr. Ashton. How DARE she say that Panic Disorder was "invented". I think she and her co-horts are strangling the medical profession, along with the entire internet's opinion of benzos. They've been trying to get a LAW in the UK passed for almost 20 years that would prevent MDs from prescribing benzos for more than 2-4 weeks. They haven't been successful. Good! No government should listen to zealots with an agenda, and I think most people would agree with this regarding ANY medication. It appears as if the UK government blows them off, and clearly, for good reason. Benzos are far from perfect. They have the potential to be addictive for some (not all). Some people need them for a week, some people for the majority of their lives. And I'm okay with that. If it makes their life better, and the benefits outweigh the risks, the decision should remain up to the patient and their MD-- not ANY government or group of people with their own very biased opinions.
* "If the indication [for the reason/use of a medication] isn't there, it must be created. In other words, a disease suitable for the drug must be invented". So, in other words, is Dr. Ashton blatantly saying that diseases are invented? Indeed. Read the whole thing. Count how many times she says "Big Pharma". Also count how many time she uses the word "drug" to replace "medication". They're usually tell-tale signs of someone being among the anti-med movement. I wouldn't think an "expert" would fall prey to using such labeling. But you know what they say about assumptions...
*Upjohn had a " clear strategy" to replace Valium with Xanax? Doctors were urged to Rx benzos over Barbs, due to the zeal of others? I recall there being pretty potent barbs out there, which were super easy to overdose on, and didn't have the anxiolytic properties of benzos. Could that have *possibly* been the real reason that MDs were urged to switch from Barbs to benzos? Just a guess... As far as Upjohn's alleged " clear strategy" to beat Valium... Show some proof, because I've looked through patents, and without proof, it sounds a tad paranoid.
*First it was getting rid of the Barbs; Then it was getting rid of the benzos; The benzos were intentionally replaced by SSRIs (which for the majority of people with GAD, don't do anything); Then Z-drugs came into the mix? Don't get me wrong, as I'm not the benzo expert, but I think you messed up the time frame for these alleged occurrences. And you claim this is all in the name of money? Sure. I believe that. They are companies who make a product, which we buy, usually out of need. And, sorry... I don't believe in a super slow taper for SSRIs or Z-drugs. I've c/t'd from both, high dose, long period of time... I *may* have gotten a headache. This isn't recommended, nor am I advising it. Can we be sensible and recall the 3 cold tapers that can kill you: Booze, Barbs, and Benzos. Where's the Ashton Manual about Ambien: How it works and how to withdrawal? Or Prozac: How it works and How to Withdrawal? If there are between 4-6 million users of Z-drugs in the UK alone, would this be a possibility in the near future? Since 20 mgs of Ambien (which isn't avialable that high anywhere I know of) equals 10 mgs in your manual, this seems pretty gosh darn important. Look at the potential risks for society-- Who knows when these insomniacs will start to IV it! Since you've quoted between 50-90% of benzo users also using illicit substances over a 20 year period, and how they start to IV benzos (wtf?), and if this is your 1:2 ratio, it would only make sense for this scenario to happen with Ambien as well. Ambien: How To Get Off In 76 Weeks. Sounds like a seller. And WHOA-- those WAY addictive SSRI's. I've tried many, and I haven't decided which one I was "addicted" to the most, or why. Was it the weight gain that I liked and became "addicted" to? The increase in anxiety? (Clearly I'm being sarcastic.)
*What is up with the protection of Valium? It's the "good" benzo for some reason, only because it can be split into 1/4 mg? I don't recall reading in the Ashton Manual about how Valium often causes depression in a vast number of people. Maybe I missed that page? I do recall a short section about Librium. I'm not sure if it was tapering from Librium by itself, or using a Valium cross-over. Librium and Valium have much in common. In addition to being very weak as far as being used for anti-anxiety purposes, their bioavailabilities are nearly the same (93%-100% for V; 90%-98% for L-- I assume that's not oral, but via IV, as getting 100% bioavailability via oral administration is rare, but I'm not certain of how these percentages were obtained.); Their metabolized half-lives are exactly the same (36-200 for active metabolites for each, yet Librium seemed to have more metabolites). See http://reference.medscape.com/drug/librium-chlordiazepoxide-342899#10. As THE leading benzo expert, do you have any data to suggest or prove that Librium causes less depression than Valium? It's been puzzling me for awhile.
*There's "nothing unique about Xanax in regards to Valium."... "All the benzodiazepines were good for panic attacks, including Valium." I can see if you made this statement in 1987, but you made it in 2007. For someone who is regarded as THE leading benzo expert, I'd like to know how this alleged Neuroscientist/Pharmacologist/person with a vague degree in Physiology claims that there's no difference between a triazolobenzodiazepine, such as Xanax, and "classic benzodiazepines". Benzos are very complicated structures, chemical-wise. Triazolobenzodiazepines, such as Xanax, have anti-depressant properties, and this has been noted since the 1980s and on, in both animal and human clinical studies, double-blind, and replicated multiple times (up to 50), and pretty damn unbiased. See http://www.ncbi.nlm.nih.gov/pubmed/10663429 as well as http://adisonline.com/drugs/Abstract/1984/27020/Alprazolam__A_Review_of_its_Pharmacodynamic.2.aspx.
*Valium can be as potent as Xanax in some cases. You'd have to increase the dosage, and if the person ever took a stronger benzo, it would be nonsense and wouldn't work. In 1981, Xanax was available to the public. This was before the SSRI class of AD's were available. Xanax is A LOT safer than barbiturates (as X is nearly impossible to overdose on), and also has less side effects than both TCA-AD's as well as MAOI-AD's. And again, even the"potent, big bad Xanax" is nearly impossible to overdose on, whereas the latter two cannot be given to actively suicidal people, as they are fairly easy to overdose on, even more so than the relatively new SSRIs. So, you don't like Barbs, benzos, SSRIs or Ambien? Point taken! Is Ibuprofen okay? I hope so. Some people have claimed to take Tylenol and they said it was like halluninogenic acid. Benzo w/d or somatism? Hmm.
*There are different anti-anxiety effects of each and every benzo, among other "properties" in each. I'm not happy, to say the least, with Dr. Ashton's generalization of "all benzos are good" for panic attacks (she later says that panic attacks were "invented by the Xanax makers"...Sigh). Not so fast, Dear Doctor. You're THE WORLD- RENOWNED BENZODIAZEPINE EXPERT, whether you wanted that title or not. Would you care to discuss the lilophilic properties of Xanax, how it outranks Valium, which leads to an often wanted (and needed) quick onset? Or how the brain is about 60-70% fat, so Xanax, with its triazolo proprieties, along with its fast onset would sometimes be preferred over Valium in many cases? I'm still waiting for a few explanations. If someone is afraid of flying on an airplane, why do MDs often give the person 1-2 mgs of Xanax instead of 10/20- 20/40 mgs of Valium? (I'm using your benzo equivalency chart as the second numbers in that section.) Perhaps because Xanax just "works better"? I am not the "leading benzo expert" and I would like some answers about many of your ideas.
*There's a huge difference between Valium and Xanax. Potency? Of course. Half-lives? Of course. Rates of addiction/physical dependence/biological tolerance after a certain time frame, even in sub-clinical/low dose rates? Debatable and subjective.* (*Note: Of course I have to admit to having a possible "bias" against Xanax, as I up-dosed on it, so my personal beliefs and feelings about Xanax cannot/should not be taken into account, or affect other people's decision to use it or not. I say "possible bias", because at the time, I had undiagnosed/under-diagnosed Lyme Disease, and was told it was MS, was put through pretty rough tests which were horrible and painful, and for 4 months of not being able to see that clearly or barely walk, I was then told it was psychiatric. I called bullshit on this one. I knew it was neurological, and it had NOTHING to do Xanax . I will never know if I would have up-dosed to such a high amount of Xanax, but when you can't walk, or see, and have horrid, painful muscle and nerve conduction studies done on multiple parts of my body involving needles--long needles, no local anesthetic can be used to get the correct test outputs. Then I was told it's probably MS, I didn't CARE how much I was taking. So don't let my experience affect your choice to use it for anxiety. It wasn't to get "high"-- it is not "Booze in a pill" as infamous Dr. Breggin claims. I'm also not saying that 1 mg of Xanax does not interfere with short-term memory problems in brand new users, because it typically does. This side effect goes away rather quickly. But you don't see me suing or blaming my GP like many do in the UK. I chose to take the medication, and was well aware--and specifically told-- that benzos could be addictive. No one forced me to take them, nor did they shove them down my mouth, force me to refill every Rx, etc. I take all responsibility for up-dosing to such an extent, as I was never prescribed 10-12+ mgs per day! But I don't blame myself, nor do I think I was "abusing" them-- it was tolerance + an odd point in my life. I had lost my father and my dog of 17 years, and had Lyme Disease, I was in school full time, worked full time, and I was a single parent. All at once. Very atypical story, and again, don't let it interfere with your opinions of Xanax. For some, it's THE ONLY med that works for anxiety.)
I'm not sure what Dr. Ashton thinks about the US and its benzo prescribing laws. Her speeches and reports come across as if American MDs are just handing out 2 mg Xanax "bars" like candy. Trust me, they're NOT. Even after years, I was never offered "bars". I've rarely known many MDs that would Rx these outside of hospital settings, and I've never met a single person who has ever been prescribed these "bars". They're not handing them out like "candy" in the US. You're lucky to even get a 1 mg tablet in the US, and that's rarely (if ever) a starting dose in most cases of anxiety disorders. So, where are all of the MDs in the US, who just hand out 4-6 gs/Xanax a day? 4 mgs of Xanax is actually a somewhat "average" dose after long term use. It's not a starer dose, by any means, and most MDs and pdocs will try to keep it at 3 mgs. Why 3 mgs? Because they're well aware of the increase in seizure risk at 4 mgs of Xanax and up. Xanax has a bad rep in the US as well, and most MDs or pdocs would not start someone off with it in the majority of cases. And the DEA knows although it is one of the most abused benzos, the average prescribed long-term user typically does NOT abuse them.
*"Panic Disorder invented by the makers of Xanax"?!? Wow. GAD has certain traits, as does Panic Disorder. Just as Depression, Minor/Major/Major Episode do-- they are usually not "permanent". I've had both GAD and Panic Disorder, and Dr. Ashton's theory is SO totally in line with anti-psychiatry thinking, that it's simply inexcusable. I almost want to say a typical BB statement-- "If THEY only knew what it was like!", because clearly Dr. Ashton does not know what it's like to wake up with a full-blown panic attack-- without A SINGLE THING causing it. That would tell most "experts" that it's a biochemical problem, and not a "made up" illness for the drug companies to scramble around to invent new diseases to cover SSRIs "dependency issues".
*"Withdrawal" generally tends to be used in the form of street drugs, such as heroin, or abused but legal substances, such as alcohol. I don't think "Big Pharma" changed the wording to "discontinuation syndrome/reaction" to fool us. I'm sure they weren't expecting any major SSRI w/d symptoms. They're fairly rare anyways, and a medication's true stats aren't available until they're on the market. That's life. WE know what it's like to withdrawal from benzos, and not via watching 300 patients. We personally know what it's like, whatever we're going to "name" it. For you to suggest that "Big Pharma" is trying to decieve us with wording alone is patronizing to us.
*I don't get the Orwellian references. And I've read it a few times.
*New classes of mental illnesses? No, we're just getting better at diagosing them due to science. (Sorry, but even a clinical exam with no lab tests run is "science" and a well trained MD should be able to tell what mental illness the person is likely to have.) I have vitiligo. If I went to some parts of the world, some people would think I was a demon/possessed with evil spirits due to an autoimmune problem regarding Melanin. "They" don't know why or how autoimmune disorders happen, but they "exist", unless I happen to be in some small tribal Aferican community. Nothing is invented or "new"--sure, bacterias and viruses replicate, but everything that exists now, mental or physical, has always been with us. We're just beginning to get into medicine with technology. I don't think it does the world any justice to walk around saying that "diseases are invented". If you're not "with" anyone, or trying to make money, can you prove that the manufacture's of Valium aren't giving you a dime? I doubt that they are giving you money, nor am I implying it, but do you see the irony in your statements? If you think this is all about money, and seem to loathe those who make money from benzos, why do you sell your book in hard cover form? It's available for free online. You can print it. I printed it, showed it to my one pdoc when I was a member of Benzobuddies after he said "Why do you want to get off of benzos?!". He was right, and WHAT A WASTE OF INK on my part. He was a temporary pdoc for a certain clinic, and he left before I could get his opinion. Maybe he read your suggestion of tapering 3 mgs of Klonopin for a YEAR AND A HALF and threw it away? I hope he had a good laugh at least.
So... Is Dr. Ashton "the leading benzo expert" or a biased zealot? As I always say, do your own research, never keep it limited to one group's or peron's set of ideas. This is my opinion, and I'm not asking anyone to agree with me.
The problem (?) is that the Ashton Manual is the ONLY one available. Does that make it automatically "good"? Of course not. Perhaps such a "manual" shouldn't even exist. I assume this is the only reason that no one else has "created" another one. There ARE suggested taper rates out there. Your MD or pdoc should have them/be able to look them up and "Big Pharma" has them as well. They are suggested and generalized, as they should be. They are not intended to be in the average person's hands, yet alone in those with anxiety disorders-- and who knows what other MI's. Manuals should exist for cars and washing machines-- not the human brain.