Quote Originally Posted by JMB123 View Post
The plan is to stick with diazepam and to slowly ween off it at 1mg a week, I have tried this approach many times before and have failed due to insomnia lasting to long got down to 6mg & quit the taper mainly due to insomnia. So with it being a 10 week taper & plus whatever time it takes for the side effects to wear off once off the diazepam insomnia etc I'm looking at months of insomnia is there a possible quicker solution?
There are no quick solutions to anything pysch related and I can't see what is proposed working this time either.

The first and likely bigger problem is how will anxiety and insomnia be treated while you're tapering off diazepam? You really need to get effective solutions running before considering weaning off diazepam.

Secondly, dropping by 1mg a week is way too fast, imo. More like 1mg every 3-4 weeks down to 5-6mg and then you may need to cut back by only 0.5mg every month, possibly by 0.25mg/month for the final 1mg.

The antidepressant I have tried escitalopram 10mg . Citalopram 20mg ,
These are essentially the same med. If one doesn't work then the other almost certainly won't either.

zoloft 50mg ,venlafaxine? Prozac 20mg mirtazapine 15mg amitrptyline 100mg imipramine? ..
The sertraline (Zoloft) and mirtazapine doeses were too low to trigger a good response. I'm guessing you quit because of insomnia before they really had a chance to work.

I tried most of these before the diazepam and all caused me insomnia except mirtazapine which helped my insomnia but that stopped working after few weeks and made me agitated.
Most serotonergic ADs may trigger insomnia at the beginning. It usually resolves after a few weeks, but may reoccur for a while after dose increases.

I'm wondering whether one of the noradrenaline reuptake inhibiting ADs, nortriptyline or lofepramine might be the answer. Definitely worth considering, imo.

Meaning that if it extends the half life of diazepam then if tapering while on fluvoxamine it extends the half life of diazepam therefore in theory making it an extended release diazepam?
Diazepam has a half-life of about 200 hours, but is only effective for 6-12 hours. Slowing the rate it is metabolised will increase the elimination half-life, but won't significantly extend its effective range.

Also would it be best to start fluvoxamine after diazepam is out of my system as you said that Benzos block how antidepressants work wouldn't while on them make the antidepressant redundant ?
It will likely reduce the effectiveness of any AD, but even a partial response may be better than nothing. If therapy is an option then it can be as effective as meds. That said, therapy seems to rely on the same neurogenesis process as ADs and there is a study, Rosen CS, 2013 [PDF] which found those taking BZDs had a poorer longer term outcome with Present Centered Psychotherapy, though not those on the Prolonged Exposure Therapy arm of the study. I'm unaware of any other studies so I wouldn't take it as gospel.

what can safely be taking aside it for sleep while I try taper diazepam.
Have you been assessed by a sleep specialist? If that is an option ask to be referred asap.