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MODERATOR'S NOTE: Because antipsychotic drugs hit many different receptors at different strengths, linear ratios of equivalence are close to impossible and the recommended equivalence is only an approximation. Thus, we recommend that members only use AP switching as a last ditch effort to get off their drug. Members should first try tapering their current AP very slowly (cuts of less than 5% per month if necessary) or holding the dose to stabilize for a long period if withdrawal symptoms are too intense. If a crossover to another drug is attempted, the member should find the minimum dose that is within range of the recommended equivalency which doesn't worsen their symptoms (or does so minimally). The crossover between drugs should be slow and symptom-based (gradual enough to avoid a worsening of symptoms). ------------------------------------------- A potentially useful resource: Dose Equivalents for Second-Generation Antipsychotics: The Minimum Effective Dose Method The article includes a huge table of equivalent doses and studies. Here's the dose data extracted: Table 2. Minimum Effective Doses of Second-Generation Antipsychotic Drugs and Dose Equivalents Drug Minimum Effective Dose OLA 1 mg Equivalent RIS 1 mg Equivalent HAL 1 mg Equivalent CPZ 100 mg Equivalent Amisulpride − − − − − Aripiprazole 10 1.33 (1) 5 (2.5) 2.5 (2.2) 4 (3.6) Asenapine 10 1.33 (1) 5 (2.5) 2.5 (2.2) 4 (3.6) Clozapine 300? 40 (30) 150 (75) 75 (67) 120 (107) Haloperidol 4 (4.5) 0.53 (0.45) 2 (1.13) 1 1.6 Iloperidone 8a (12) 1.07a (1.2) 4a (3) 2a (2.7) 3.2a (4.3) Lurasidone 40 5,33 (4) 20 (10) 10 (8.9) 16 (14.2) Olanzapine 7.5 (10) 1 3.75 (2.5) 1.88 (2.2) 3 (3.6) Paliperidone 3 (6) 0.4 (0.6) 1.5 (1.5) 0.75 (1.3) 1.2 (2.1) Quetiapine 150 (250) 20 (25) 75 (62.5) 37.5 (55.6) 60 (88.9) Risperidone 2 (4) 0.27 (0.4) 1 0.5 (0.9) 0.8 (1.4) Sertindole 12 (16) 1.60 (1.6) 6 (4) 3 (3.6) 4.8 (5.7) Ziprasidone 40 (80) 5.33 (8) 20 (20) 10 (17.8) 16 (28.4) Zotepine − − − − −

Hello everyone, I am a longtime lurker, only first posting now as I get ready to begin my taper from Remeron (Mirtazipine). I am seeking support here for my taper as I cannot count on support from my doctors. My husband is minimal support as he has his own mental health issues and we have a new baby. I'm ready to come off the Remeron mostly because I don't want to be on it forever and I feel like it got me through the hump of the early postpartum period, which was what I needed. I have gained 15-20lb on this med which is annoying because I am not one to gain weight normally, so I know it's the drug. I lost all the baby weight within the first month after I delivered and didn't start Remeron until month 2. I feel tired all the time (though it does help me sleep as i take it at night), and it makes me crave sugar and carbs like crazy. I'm also now starting to experience bodyside joint pain, which I've never had before. That seems to go away somewhat when i eliminate wheat from my diet. I have gotten my doctor to order me a solution of mirtazipine from compounding pharmacy, but after paying $54 fir an Rx that I usually get for free, I think I will try making my own solution using the tablets and the Oraplus I read about in the forums here. I'm nervous to begin my taper because the first time I tried at the beginning of December I went down by a 1/4 tablet for a week and every day I had excruciating headaches. BY the end of that week I was experiencing nausea and anxiety. AS SOON as I reinstated my full dose, all symptoms disappeared. I have a feeling I'll need to begin my taper at 5% rather than 10% given how sensitive I am. I would love to hear some encouraging success stories of coming of this drug slowly, as it seems it will take me long rot get off it that I was even on it to begin with. Other relevant info: I am 5 months post partum, have been on Remeron for 4 of those 5 months. I am married and have another child who is nearly 11 years old. I work part time and used to have regular exercise and meditation practices that have both fallen by the wayside with the new baby. I also can no longer tolerate alcohol. I've been off alcohol for several years (not because of AA or addiction issue, but because it makes me feel awful), and recently I thought I would try a half glass of wine with the holidays. Big mistake. Major depression and anxiety the next day. Good riddance.I'd much rather feel well and not drink at all. I think that's it for now!

Hi everyone, TLDR: 1. Is 10mg of fluoxetine a day a reasonable starting dose for someone who's been trying unsuccessfully to taper at 40mg per week? 2. Could the days of missing doses been causing my nervous system harm, considering fluoxetine's half life i.e. is skipping days feasible with fluoxetine tapering? Edit: My longest steady dose (over the 3 years) of fluoxetine was 20mg per day but I am not sure, my memory is hazy. The long story: I've been on fluoxetine for about 3 years. Over the last 10 months, I've had a very disrupted dosing of fluoxetine. My best period was last December when I was happy on 40mg of fluoxetine weekly but my doctor told me to stop suddenly, which I did. Early this year I was back on fluoxetine and taking it for the most part daily. However, I craved the happy balance I had taking it weekly as I had minimal side effects (mostly sleeping too much) but I was able to practise my CBT effectively for my OCD. Sadly, since May I've had a few bad attempts at reducing my dose and this was all before I learned about tapering properly. I had just thought tapering made sense so I tried it my own way but I was not prepared for the horrible withdrawal symptoms I've had recently. Last month I was on as little as 40mg every two weeks but I think I've been feeling the aftermath of that recently. I updosed (again before learning about this site and tapering properly) and I went on daily fluoxetine at 20mg for a couple of weeks. The last month I was on 40mg each week and I found symptoms were bad around day 5/6. So, having found this website, I want to taper properly. Each time I had a withdrawal symptom I always ran back to fluoxetine like a good little addict and up-dosed like an ignorant buffoon. In any case, I am ready for the 10% taper and have invested in a Gemini 20. I will dry cut for the first few months. I am just deciding what my current/starting dose should be because I've made such a mess of things over the last few months and with fluoxetine's long half life, it is hard to know where I am. My proposition is: Starting today, taking 10mg per day (I got tablets from the pharmacy as opposed to pills so I can divide them easily). I'm sorry for my messy post but my record keeping has been regular but erratic this year so I am piecing bits together to get a picture of what the hell I've been doing with this powerful drug. Thank you all for this place. I've read so much the last week and it is nice to know people are going through what I am and are doing so well.