I reached the closest thing psychiatric drug withdrawal has to an authority while I was begging for help. I got confused by our communication - so I'm going to just show you what he wrote.
Of everyone in this story, he is the one I expected the most from - and that is exactly why it is the one that still stings.
Mark Horowitz is the closest thing psychiatric drug withdrawal has to a household name in the last few years. He is the co-author of the Maudsley Deprescribing Guidelines, the psychiatrist who put the science of slow exponential tapering for all psychiatric drugs on the map, the man the community quotes back at its own doctors. He has lived experience of withdrawal himself from Antidepressants, which is part of why people trust him. When I found his work, deep in the worst of it, I felt something close to hope: here, at last, was a credentialed person (beyond Dr Ashton for benzodiazepines) who understood and adovcated loudly that you cannot rip people off these drugs.
So on 12 June 2023 - barely sleeping, my whole nervous system on fire - I wrote to him through the feedback form on his website, after seeing an interview he'd given to the Benzo Warriors Community. A frightened patient sending a message in a bottle. I wasn't asking him to treat me. I had one technical question I couldn't solve alone. I already knew about the exponential tapering through the benzo groups and created my own excel sheet to calculate my daily tapering as I mentioned in previous parts.
To his credit, he replied the next day - more than most of the "experts" in this story ever managed:
"Hi Guy, I received your email - sorry to hear of your trouble coming off your medication. It can be a very confusing area! As I get contacted so frequently for advice on this topic I have started offering academic consultancy on how to navigate all the questions you have asked via video call. Let me know if you would like further details on these sessions."
I said yes, tell me more. The details came the following day:
"I offer academic consultancy for $250 for a 50 minute session on the understanding that even though I trained in Sydney I am not currently registered for practice in Australia (I work in the UK) and so cannot take over care or write prescriptions."
"… this is mostly aimed at Americans, you can pay AUD250 through here…"
I couldn't really afford $250 - AU or US. I already knew the 'technique', my sheet was officially going to be used in the community, the details on HOW to taper (5-10% every 2-4 weeks from the current dose) were known - in the Beating Benzos guides and in the NICE (the Uk's) guidelines. I'm unemployed because of this illness; I told him so. I sent him the tapering spreadsheet I'd built for myself - a tool that takes your drug and dose and gives you a schedule of ever-smaller cuts - and asked my one real question: how do you handle the very end, the long "tail" where the cuts get impossibly small? It didn't require more than a minute to answer. In benzos, the Ashton Manual gives a number: the equivalent of 0.5mg diazepam - as the jump dose. the equivalent tables exist. Knowing what I know now from his guide - he either didn't know this, or completely ignored it in his own book. The only issue for me, and many others, was that as the cuts become smaller and smaller it of course gets longer and longer to get to this magic number. I thought he - as he was 'in the know' doing experiments on actual Receptor Occupancy etc - will give me a concrete answer to some formula or numbers that will make it faster. I saw his graphs in the interview, and I thought there are 'magic numbers' that make it faster somehow but where not mentioned. Sadly, my cognition was not at it's best, as he also I believe gave a table, which ended up in the maudsley for diazepam, and the numbers had the same 'pretty numbers' issue i refer to later, if my brain was working properly I would have immediately realised his 'tables' are going to be nonsense, and saved me the suffering waiting for his 'professional' answers. But I honestly thought there are numbers for EACH drug and that Diazepam stands on it's own, so i didn't really look. His reply:
"Your suggested regimens are not hyperbolic they are exponential - ie. they decrease by a percentage of the previous dose each period. A hyperbolic regimen is one that follows the receptor occupancy of a drug (i.e. its effect on the brain) and to determine this you need to perform nuclear imaging of the brain to work out the degree of occupancy for each dose. There is no way to fix the exponential dose reductions - it is an infinite regress that never ends. I think these rules of thumb are helpful because they are simple to follow but they do not make sense at the end of a taper."
I went back to Google to check the difference between the two words. He really confused me - and what makes that reply so strange is what he was saying about the exact same terms in public.
In his Benzo Warriors interview - the one that brought me to him in the first place - he was relaxed about it. There, he told the audience that exponential and hyperbolic tapers are, in practice, almost the same thing:
"Exponential reductions are very similar to hyperbolic reductions… 2.5% reductions of GABA are very similar to say 10% reductions of dose… this just shows you how similar exponential and hyperbolic tapers are. I'm not criticising - I'm just showing there are some small differences at the end."
He even noted that England's (NICE) official guidance now recommends exactly this, using the word "proportionate" - which, he said, is "another word for exponential reductions." So in public: SPECIFICALLY because you can't really take everyone and somehow see their individual receptor occupancy 'graph' - my approach (and the standard approach for benzos - he didn't reinvent the wheel!) was fine - near-identical to his, and the thing the guidelines were moving toward. In private, when a sick stranger asked for help, the same approach became "not hyperbolic" - a lesser, almost-wrong thing that supposedly needed nuclear brain imaging to do properly.
This is where the title of this part comes from. Strip away the branding and "hyperbolic tapering" is, by his own public account and mine, percentage tapering - reduce by a slice of your current dose, smaller and smaller as you go. It is what the benzo groups and Professor Ashton (to a lesser extent as with her it was lineaer 'with gear shifts in speed' due to not having cheap milligram scales) were already doing; it is what England now calls "proportionate." Calling it "hyperbolic" isn't exactly wrong - the word describes the dose-to-effect curve - but for a frightened patient it is a confusing name for a simple idea, and being told mine was "not hyperbolic" taught me nothing. It just made me feel I'd got it wrong.
And look at what the correction actually conceded. To do it "properly," he wrote, you would need to put a patient through nuclear brain imaging before each dose cut - something no one tapering at their kitchen table can do. In the same breath he admitted the percentage method "never ends" - "an infinite regress" - and that the rules of thumb "do not make sense at the end of a taper." The end of the taper was the only thing I had asked about. He had just told me, in writing, that the most important stretch is the one nobody has a clean answer for - and left it there.
Through that autumn I kept waiting on the guidelines themselves, and kept asking my one question. In October 2023 I wrote to ask when the textbook would be out (it was already supposed to be out). This is what came back:
"The textbook will be published in Feb/March next year. I don't mind you pinching from it, but the publishers might be less impressed (they own it now, not me!). Maybe if you suggest to some of the better off people to buy a copy of the book, my publisher might be more well bestowed to you…"
I have read that line more times than I can count. I'm not going to tell you what was in his heart when he wrote it - I genuinely don't know, and I won't pretend to. I'll only tell you how it landed on the person it was sent to: SHOCK. A man who had just explained he was too sick to work and couldn't pay, being asked to go and find the "better off people" in his support groups to buy a book, so that a publisher might look more kindly on him. My spreadsheet was FREE. I wasn't making money out of it (there was a donation paypal email - and until today, with 1000s of people downloading it, I didn't even get one dollar back from the community for the resource). I answered the only way I could that day:
"I am currently really suffering.. stopped the taper and trying to stabilise and try supplements and CBD to help me. It's so disappointing that it's all about money and 'rights' when I ask for a simple question!… please don't be cruel and just share. I am sure it won't take away from your profits."
And here, in fairness - because it is his right to be quoted fully, and because I want you to judge the whole man and not a clipped version of him - is how he answered that:
"I am sorry to hear you are in so much trouble. I am not concerned with my profits - they will be a few cents an hour for the work I have done! What I do care about is that the publisher gets a return on investment so that they let me keep writing the book so it can eventually be on doctor's desks so that this disaster stops happening. If few copies are sold they will bin the book and it will never get traction amongst doctors."
I want to take him at his word that he isn't getting rich from this.. but to be honest I don't really care if he does or not. I believe the book matters and that getting it onto doctors' desks is a genuinely good cause. So let me be precise about what I object to, and let me flag clearly that this next part is my opinion, not a statement of fact about his motives: I think there is something badly wrong with a field where the answer to a very sick man's one practical question, especially when in effect you DON'T have a good answer beyond the method he is already using and that's publicly, FREELY out there - is, in effect, read the book when it comes out, and meanwhile get the better-off people to buy it. The cause may be noble. But I was the person on the other end of it, and what I needed wasn't a marketing plan. It was one number.
I want to be accurate about what happened next, because the truth is more ordinary than betrayal, and in a way that makes it worse. He didn't vanish. He kept replying, up to a point when he just ignored me. He even sent a real, detailed explanation of hyperbolic versus exponential tapering, attached a chapter from the book, and asked which drug I was on so he could point me to the right guidance. I won't deny that.
But the one concrete thing I needed - how to cross the very end without it taking years or breaking me - never arrived. Not even just a table for Clonazepam, specifically. When I pushed once more, in November 2023, after asking him directly for help again with the Clonazepam tail, this is what I got:
"I am not sure what you are after - you are already tapering about as slowly than the guidelines we put together - and you clearly understand that you need to go at a rate you can tolerate."
I'd told him, more than once, that I was really suffering. I am not sure what you are after. Mate, it's there! black and white. I understood, reading it, that the conversation was over - not slammed shut, just quietly allowed to lapse, which when you are desperate is its own kind of answer. And when the guidelines finally arrived many months later, the tail in them was - as I lay out in detail in my review (please read it! it's one of the other articles here) - a set of steps built around the tablet and liquid sizes that happen to be commercially available, not the jeweller's-scale precision the bottom of a real taper demands. It was in fact much WORSE than what he promised - way more different than the 'hyperbolic' theory he promoted - and far off the 'exponential decay' simple math that was 'so close'. The one part I could not work out alone, from the one person who literally named the method supposedly by research of receptor Occupancy under the microscope, was now again the one part I had to solve myself. The amazing thing? he became the favourite guest in almost every podcast on youtube. And to my horror, the NSW and QLD Australian state governments adopted his tables! I could not find ONE critical voice against it.
There's one more thread, and it matters because it's where his confidence and his actual knowledge came apart. In that same November email, when I mentioned that a doctor (you'll meet him in Part 9) wanted to taper me off the benzodiazepine using CBD oil, he warned me off it:
"[Dr Mehta] sounds like he is going to switch you from a benzo to CBD - not sure if that is such a good deal to take."
Thats it. A fryptic warning with no further explanation. And it wasn't just to me. In the Maudsley guidelines themselves, CBD is waved away in a single breath - lumped in with phenibut (a genuinely addictive drug) and valerian as "particularly unwise" to take during withdrawal. A substance with a strong safety profile, grouped with an addictive one and dismissed in a sentence, in a book thousands of suffering people read as gospel.
Here is the problem: HE WAS WRONG - At least when it comes to my lived experience. CBD oil - the right oil, at the right time - became part of (with other supplements) what finally got me off the drug, after everything else had failed. I'll tell that whole story in Part 9. The thing he told me, and told his readers, was "particularly unwise" was, in the end, THE THING THAT SAVED ME.
And here is the part I have on tape. At a public webinar he gave to the Australian Society for Psychological Medicine, I asked him in the chat why he warned people off CBD. Before answering, he said this:
"So I can't say I'm very familiar with those products, but my general approach is… if you take another drug that conceals withdrawal symptoms what you'll end up doing is switching drugs, not stopping drugs. So it's a bit like if you're quitting whiskey but you're drinking wine - you're going to end up dependent on the other drug."
I want to be fair to the reasoning first: the trap he's describing is real. Coming off a benzodiazepine only to lean on something equally habit-forming (for example - ANOTHER benzodiazepine, or gabapentin and other drugs in this class) would just be swapping one dependence for another, and a careful clinician should warn about that.
But that is not what CBD is - and this is exactly where "not very familiar" stops being a footnote and becomes the whole problem. IF YOU ARE NOT FAMILIAR - WHY INCLUDE IN THE BOOK? CBD does not act on the benzodiazepine receptor at all (and I HAVE used supplements that do but in a very different way to Benzos). It is not a sedative you grow dependent on the way you do a benzo: the World Health Organization's expert committee concluded in 2018 that pure CBD "exhibits no effects indicative of any abuse or dependence potential." It works through entirely different pathways - mainly the serotonin system (the 5-HT1A receptor), plus a gentle, indirect steadying of the GABA system at a site that is not the benzodiazepine site - rather than by occupying the receptor the benzo is vacating. It also barely touches the cannabinoid receptors that THC acts on (THC btw also helped me a lot with sleep, but it is much more of a 'wildcard' for people who are highly sensitized). So it simply isn't "another drug that conceals withdrawal" in the sense he meant; it is closer to helping a raw nervous system settle while it heals, or taking paracetamol when you have fever and pain from an infection.
And his own analogy gives the game away. Whiskey and wine are the same drug - alcohol - which is precisely why swapping one for the other changes nothing. A benzodiazepine and CBD are not the same drug, do not act on the same receptor, and do not carry the same dependence. The comparison only holds if you don't know how CBD works - which is what he had just told the room.
Sit with that. The same man whose book confidently files CBD under "particularly unwise," in the same breath as an addictive drug, told a room full of doctors he wasn't very familiar with it - and then described it with an analogy that the basic pharmacology doesn't support. When I emailed afterward asking him to explain the contradiction, I never got a reply. I asked more than once.
That, in my opinion, is the quiet disservice underneath all the rest: not just that he was unreachable to me, but that the confident dismissals in his book - the ones doctors and patients now quote - aren't always backed by the knowledge the authority implies. I got lucky and ignored him. I think about the people who didn't, and are too scared to use something that might ACTUALLY SAVE THEM.
The strangest part came over a year later. By December 2024 I was finally off the drug, having clawed my way out without his help, and I'd made a video reviewing the Maudsley guidelines. Out of courtesy I wrote to ask whether I could discuss the conversations we'd had. That is what brought him back (after ignoring me):
"Hi Guy, I would prefer a private conversation not to be aired publicly, thanks. Best, Mark"
I replied honestly - and this is, word for word, what I told him at the time:
"I personally don't see your response as a practitioner to my questions as private as these were professional questions and answers… This is public interest and related directly to the topics I bring up. In any case I don't consider this or future correspondance with you as private. I have published my video, you are welcome to respond to it."
I took the cautious path anyway. In that video review I described only, in general terms, that I'd reached him during severe withdrawal and that we'd discussed exponential versus hyperbolic tapering and the CBD question. I left his exact words out.
I'm putting them in now - all of them, including the ones that show him at his most decent - because I've sat with it long enough to know it isn't gossip. It's the truth about how the supposed safety net actually behaves when a real person falls into it. And it's a matter of genuine public interest: thousands of suffering strangers quote this man's guidelines back at their own doctors, and they deserve to know that the authority is human, fallible, and - when I needed him most, and couldn't pay - out of reach in the one way that mattered.
I had to find the bottom of the taper myself. Luckily, I did. And the person who finally helped me get there had no credentials at all. Just a phone, an open door, and the willingness to pick up.