Christian Monsalve, MD

Part of our Provider Spotlight series: short interviews with prescribers who support slow, patient-led benzodiazepine tapers. Answers are the provider's own, lightly edited for formatting, and approved by the provider before publication.

Christian S. Monsalve, MD is a board-certified psychiatrist and the founder and medical director of Verigrate Health, a private telepsychiatry practice built around precision medication tapering. He sees patients in 43 states and Washington, D.C., primarily by telemedicine, with in-person care available in Dallas, New York, and Miami.

How do most patients find you, and where in their taper are they when they arrive?

"Most patients find me through AI search tools or directories such as Benzoinfo.com and Psychology Today. They come at very different points in the process. Some want guidance from someone experienced in tapering before they make the first reduction. Others have struggled with a previous rapid taper and want to approach it more carefully this time. And some have reached a standstill because the commercially available formulations simply do not allow for reductions small enough for them to tolerate."

What does hyperbolic tapering look like in practice, say for someone on 1 mg of clonazepam?

"It means that the reductions generally become smaller as the dose gets lower. A reduction from 1.0 to 0.9 mg may be quite different from a reduction from 0.2 to 0.1 mg. Both are 0.1 mg on paper, but the second represents a much larger proportion of the remaining dose, and the pharmacologic effect of those reductions is not necessarily equivalent. In practice, the taper becomes more precise as we approach the lower doses. The goal is not to follow a rigid schedule, but to make reductions that the individual patient can tolerate and adjust as we learn from their response."

How do you set the pace, and what happens when symptoms flare mid-taper?

"I often tell patients that the pace is ultimately set by their body. We can design a thoughtful plan, but the patient's response tells us when it is time to make the next reduction. If symptoms flare, it may mean the previous decrease was too large, we moved too quickly, or the nervous system simply needs more time to adjust. Those symptoms often settle with time. Rather than seeing a flare as a failure, I see it as useful information that helps us refine the taper for that particular patient."

How do you handle doses smaller than the smallest tablet?

"At the lower doses, and sometimes much earlier depending on the medication, we often need to move beyond standard tablets. That may mean a commercially available liquid, a compounded formulation, or carefully combining different dosage forms. The purpose is simple: to make reductions small and precise enough to tailor the taper to the patient rather than forcing the patient to fit the limitations of available tablet sizes."

What's your view on protracted withdrawal, and how do you support patients through it?

"It exists, and I think it is important to acknowledge that without assuming that every persistent symptom is necessarily withdrawal. For many patients, symptoms gradually improve with time, although it can be very difficult to predict the timeline for an individual person. During that period, psychotherapy, reassurance, sleep, routine, and supportive medical care can be very important. If someone develops severe symptoms such as akathisia or suicidal thinking, that requires careful and sometimes urgent clinical assessment. In those situations, judicious intervention may be necessary while still trying to avoid creating additional medication problems."

Who is a good fit for your practice, and who isn't?

"Someone who genuinely wants to reduce medication burden when it is clinically appropriate and is comfortable with a gradual, individualized process. Many patients I see have already had difficulty with a previous taper or have reached doses where very small reductions are necessary. Someone whose primary goal is indefinite continuation of benzodiazepines or other controlled substances is generally not the best fit for the practice."

What would you say to someone whose prescriber wants them off in four weeks?

"I would tell them that a gentler, more gradual taper is an important alternative worth considering. There are certainly less frequent emergency situations in medicine where a faster taper may be appropriate, but for someone who has been taking a benzodiazepine regularly, there is often no reason to make the process more difficult than it needs to be. A slower approach can give the body time to adapt and may reduce unnecessary withdrawal symptoms and suffering along the way."

Anything you wish every patient knew before starting a taper?

"I want patients to know that there are very good reasons to remain hopeful. I have seen people successfully complete tapers after taking benzodiazepines for many years, including decades. A difficult previous attempt does not mean that the next one will go the same way. Sometimes the difference is simply having a slower plan, smaller reductions, enough time between them, and someone willing to listen carefully to what the patient is experiencing."

Dr. Monsalve also appears in the prescribers we have vetted section of our doctor-finding guide. If you're preparing for a first appointment with any prescriber, bring a written schedule from the taper calculator and the five vetting questions from the doctor guide.

Disclosure: Provider Spotlights are free. TaperOffBenzos never accepts referral fees or per-patient payments from any provider. This spotlight is education, not a referral or an endorsement of outcomes. Answers are the provider's own, lightly edited for formatting, and approved by the provider before publication. Are you a prescriber who supports slow, patient-led tapers? Introduce yourself.