Judy Tsafrir, 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.

Judy Tsafrir, MD is a psychiatrist and psychoanalyst practicing holistic adult and child psychiatry in Newton, Massachusetts, and the author of Sacred Psychiatry: Bridging the Personal and Transpersonal to Transform Health and Consciousness. She sees Massachusetts residents by telehealth or in person; patients who live in other states are seen in person at her Newton office.

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

"Most patients find my practice by either googling holistic psychiatry, or integrative psychiatry or by going to the website of the Benzodiazepine Coalition where I am listed as a practitioner. Some patients are contemplating tapering and want to do it with medical supervision, some have tried to taper themselves on their own and have run into trouble and others have been tapered by an inexperienced clinician who has not done it skillfully and they are experiencing withdrawal symptoms."

What does a taper look like in your practice, say for someone on 1 mg of clonazepam?

"I rarely agree to take on prescribing right away after the initial consultation. I ask that my patients demonstrate to me that they are committed to taking a holistic approach to their health. At a minimum, I ask them to follow an anti-inflammatory diet and to do a nervous system retraining program before I take over prescribing. There are also many other lifestyle recommendations that can make a huge difference for a successful taper related to sleep, sunlight and appropriate movement if they are willing.

When we begin the taper, I want them to be stable and not in a state of acute withdrawal. That means that their current clinician would continue to prescribe at the dose they had been taking. When I take over, I typically start with a 10% reduction, so the first reduction would be 0.9 mg. Further reductions are based upon the patient's tolerance. If 10% is comfortable and there are minimal withdrawal side effects, then we continue at that rate. If it's too much, then we may go slower and reduce by 5%. Some months we may not reduce at all until the patient stabilizes and feels comfortable. It is very much patient led. I use a compounding pharmacy for medications."

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

"I follow my patient's lead and their symptoms and try and find a dosage that works for them. If that means increasing the dose in order to stabilize before continuing the taper, that is what we do."

How do you handle doses smaller than the smallest tablet?

"I use a compounding pharmacy."

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

"Patients who are interested in taking a holistic approach are a good fit. I like to help patients with their spiritual and emotional lives. I am trained as a psychoanalyst and an astrologer. Patients who appreciate talking with a highly trained person about their lives, their thoughts and feelings in addition to tapering off the medications are a good match. Patients who have an interest in astrology, tarot and spiritual questions such as life purpose are a good match.

Patients who just are looking for a prescriber and are not interested in taking a holistic approach are not a good fit. Patients who are in acute crisis, suicidal or in need of hospitalization are not a good fit. I am not willing to work with patients who are in crisis. A patient needs to be in a stable condition if they want to work with me. Patients who are significantly suffering are welcome, but those in crisis are not appropriate for my practice. I also only am willing to work with patients whose family is in agreement with the taper. If a spouse is opposed to the treatment, that is also not a good fit for my practice. Patients should also have social support and not be totally isolated.

I am not affiliated with any insurance companies. I do provide a receipt for payment with all the billing and diagnostic codes that a patient can submit themselves for reimbursement, but I do not submit insurance claims."

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

"I don't have any special magic other than what I have already written about. A holistic approach that includes proper diet, dedicated attention to nervous system regulation, and other common sense health practices like fresh air, sunlight, appropriate movement. Sometimes a referral for acupuncture, homeopathy or other kinds of body work/energy healing can be helpful."

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

"I would say that it is not realistic and that it would not be surprising if that approach resulted in a severe withdrawal syndrome that could be very uncomfortable as well as traumatizing."

Anything you wish every patient knew before starting a taper?

"It is important to understand that tapering from benzodiazepines is truly a marathon and not a sprint. Everyone is different, and the taper needs to be tailored to their unique physiology and condition. The more that they are not in a rush, and have the capacity for patience with themselves and the process, the more likely they are to be successful."

Dr. Tsafrir 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.