What Happens at a First Consultation With Dr. Leeds

Key Takeaways

• A first consultation is a one-hour conversation with Dr. Leeds, by video or audio, about your options.
• A consultation is not a medical visit, does not create a physician-patient relationship, and does not commit you to a taper.
• It starts with your full medication history, including earlier attempts to stop and the symptoms you have now.
• Informed consent covers the risks first, then the benefits, the alternatives, an exit plan, and your right to say no.
• A taper has to be gradual, because stopping suddenly can cause seizures and raises the risk of protracted withdrawal.
• The pace of the taper is yours to direct, and tapers commonly run a year to 18 months or longer.
• The practice is a concierge practice that does not bill insurance and treats patients in Florida only.

What happens at a first consultation with Dr. Leeds?

What happens at a first consultation with Dr. Leeds? Mostly, he listens, and then he explains. Nobody is handed a taper schedule in the first ten minutes.

If you have been taking a benzodiazepine for years, you may have already sat across from a doctor who told you that your symptoms were just your anxiety coming back. Or, you may have been told to simply stop taking it. Both of those experiences leave a mark, and it is reasonable to walk into a new consultation with your guard up.

The consultation is built around that reality. It is a conversation about your medication history, the risks and the alternatives, and the shape of a gradual taper that you would direct. So, what actually gets covered, and what does not?

A consultation is not a medical visit.

The first thing to understand is that a consultation with Dr. Leeds is not a medical visit, and it does not establish a physician-patient relationship. It is a conversation between an osteopathic physician who specializes in deprescribing and a person who wants to understand their options. The consultation is a one-hour meeting with Dr. Leeds, by video or audio.

That distinction protects you. You can have a consultation without any obligation to continue as a patient, and some people do exactly that, taking what they learned back to their own prescriber. Dr. Leeds prefers to hold this conversation before any medical treatment begins, so that nobody starts a taper without knowing what a taper involves.

While that may sound like a formality, it is the opposite. Many patients who arrive with benzodiazepine dependence describe being started on the drug in a short visit where the exit was never discussed. The consultation is the visit they should have had at the beginning.

The history comes first.

Dr. Leeds begins with the full history of the medication. That means which benzodiazepine you take, such as Xanax (alprazolam), Klonopin (clonazepam), or Ativan (lorazepam), or which z-drug, meaning a sleeping pill such as Ambien (zolpidem) that works by the same mechanism. It also means how much, how often, for how long, and how the prescription started.

Then comes the history of stopping. Have you tried to come off it before? Did a doctor cut the dose quickly, or did you stop cold turkey and end up back on it? Each earlier attempt matters, because repeated rapid withdrawals can make the nervous system more reactive to the next one, a pattern known as kindling.

Your symptoms get the same attention. Many patients describe new symptoms that appeared while they were still taking the same dose, which is called tolerance withdrawal, or symptoms that arrive a few hours before the next dose is due, known as interdose withdrawal. The other medications you take are part of the picture too, since they affect how a taper is planned.

Somewhere in this history, one fact usually becomes obvious. The person telling it took the medication exactly as prescribed, and the body did what bodies do with a benzodiazepine taken daily for months or years. That is physical dependence, and dependence is not addiction. It is a medical condition caused by the prescription, and it calls for a medical taper rather than an addiction program.

Informed consent means risks first.

The second part of the consultation is informed consent, and Dr. Leeds does not treat it as a signature on a form. It starts with risks. Tapering a benzodiazepine can bring withdrawal symptoms, some of them severe, and the process often takes many months.

Then come the benefits and the alternatives. One alternative is to stay on the medication for now, and another is to change nothing at all while you think it over. In 2020, the United States Food and Drug Administration (FDA) updated the boxed warning on benzodiazepine labels to cover physical dependence and withdrawal reactions, warning that stopping abruptly or reducing the dose too quickly can cause withdrawal reactions, including seizures, and that discontinuation calls for a gradual taper. Many patients were never told any of this when the drug was first prescribed, and Dr. Leeds tells them now.

Consent also includes an exit plan, meaning how long a taper is expected to run and how the plan will change if symptoms flare. And, it includes your right to decline. You may say no to a taper, you may say no to any part of the plan, and you may change your mind later without losing the relationship. Consent is a conversation that continues at every visit, not a box that gets checked once.

Why does the taper have to be gradual?

Benzodiazepines act on the receptor for gamma-aminobutyric acid (GABA), the brain’s main calming signal. Taken daily for a long time, the brain responds by turning that system down, so that the drug is needed just to feel normal. Remove the drug suddenly, and the calming system is left underpowered while everything it was holding back comes forward.

This is why stopping cold turkey is dangerous. It can cause seizures, and it raises the risk of a long, protracted withdrawal. If someone has a seizure or severe symptoms after stopping a benzodiazepine abruptly, call 911 or go to the nearest emergency department, and for thoughts of suicide or self-harm at any point during a taper, call or text 988, the Suicide and Crisis Lifeline.

An analogy that may help is a dimmer switch. Turning the knob down a notch from full brightness barely changes the room, yet the same turn near the bottom of the dial takes the room from dim to dark. While no analogy is perfect, this is roughly how dose and effect behave with benzodiazepines, and it is why the last steps of a taper are the smallest.

Fortunately, this has been understood for a long time. Chapter II of the Ashton Manual, written by Professor C. Heather Ashton and available at benzo.org.uk, describes a slow withdrawal in which the patient stays in control of the rate, and the Maudsley Deprescribing Guidelines describe reductions that get progressively smaller as the dose falls, known as hyperbolic tapering. The size of each step is decided by how you respond, not by a calendar.

You shape the plan, and Dr. Leeds shapes it with you.

The last part of the consultation is the shape of the plan itself, and here Dr. Leeds explains rather than dictates. For many patients, he suggests a crossover taper, meaning a gradual switch from a shorter-acting benzodiazepine to diazepam (Valium) before the dose comes down, following the approach described in the Ashton Manual. For others, a same-medication taper fits better, and the reasons for each are laid out plainly.

He also explains how the reductions themselves work. Compounded liquid formulations allow very small, precise steps, and holding a dose steady when symptoms spike is treated as part of the plan rather than a failure. If the pace is too fast, the doctor should slow it down. If it feels too slow, patient and doctor may agree to go a bit faster, as tolerated, which is what patient-directed dose adjustment looks like in practice.

Unfortunately, nobody can promise how long this will take. Tapers commonly run a year to 18 months, and often longer, because the timeline belongs to your nervous system rather than to a schedule. What Dr. Leeds can promise is that the pace is yours to direct.

How does the concierge practice in Florida work?

The practical questions come last. Dr. Leeds’ practice is a concierge practice, which means it does not bill insurance, and it treats patients in Florida only. Visits are by telemedicine for patients across Florida, in-office visits are available in Fort Lauderdale, and the office takes calls Monday through Friday from 10 AM to 2 PM.

There is one physician. Every visit is with Dr. Leeds, never with a substitute prescriber, a coach, or a non-physician practitioner. There are no group sessions, no facility stay, and no hand-off to anyone else, which is what medically supervised benzodiazepine tapering means here: one doctor and one patient, over time.

The way in is the contact form on this website. After you send it, follow-up comes by email or by phone, and the consultation is scheduled from there. What you do with what you learn is up to you.

Frequently asked questions

Does a consultation commit a patient to starting a taper?

No. The consultation is a conversation, not a commitment, and it does not create a physician-patient relationship. Some people use it to understand their options and then continue with their own prescriber.

What should a patient have ready before the consultation?

A list of every medication you take, with the dose and how long you have taken it, is the most useful thing to bring. Notes on earlier attempts to stop, and on the symptoms you have now, help as well. If you do not have exact dates, that is fine, and Dr. Leeds will work with what you remember.

Does the practice accept insurance?

No. It is a concierge practice and does not bill insurance, and it provides medical care to patients in Florida. Those two facts are worth knowing before the consultation so that the conversation can be about you rather than about paperwork.

Dr. Leeds’ practice exists for people who took a benzodiazepine or z-drug as prescribed, developed physical dependence, and want to come off it slowly and safely with a physician who understands what that involves. The first consultation is where that begins, with a history, an honest conversation about risks and choices, and a plan you help to write. Contact the office today to ask about a first consultation.

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.