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Before you begin tapering - what you need to know


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#1 Altostrata

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Posted 03 August 2011 - 01:20 PM

Reducing dosage or “tapering” of a psychiatric drug can be a challenging experience because of

 
Please carefully consider your ability to meet the challenges of tapering in the context of both your current wellness and life situation.
 
Other posts in this thread
 

DO NOT START TAPERING if ...

 

Will how I quit affect potential symptoms?

 

Why taper so slowly?

 

Is it withdrawal or relapse?


Stages of Withdrawal: Acute and Post-Acute

 

Keep notes on paper about your drug dosages and daily symptom pattern


Edited by Altostrata, 27 September 2016 - 11:09 AM.
updated

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#2 scallywag

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Posted 21 August 2016 - 06:08 PM

Do not start tapering if …

 

Our experience is that certain personal situations destabilize your CNS (central nervous system). Reducing dosage of neuroactive drugs when these destabilizing conditions exist will likely make a difficult situation even worse.

We strongly urge that you NOT START tapering or that you HOLD AT CURRENT DOSE if you

  • reside in a violent, abusive, or traumatic living situation
     
  • struggle to make decisions for yourself and stick to them
     
  • are in a crisis situation which needs face-to-face support and assistance
     
  • have health anxiety, i.e. experiencing a symptom (or learning of the possibility of it) affects your ability to take effective action
     
  • start or already participate in intense emotional therapy for previous traumatic events

 

In destabilizing situations such as these, you are better off to deal with and resolve the situation with stable medication levels. Tapering will always be an option. It's not "never taper", more of "now isn't the right time to taper."

 

Please note that this site is for tapering and withdrawal syndrome. We cannot offer counseling for these stressful life situations and we are not staffed for crisis counseling.

 

We urge you to seek face-to-face help rather than on this online forum for these situations.


Edited by Altostrata, 22 August 2016 - 01:38 PM.
added note in red


#3 scallywag

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Posted 21 August 2016 - 06:13 PM

Withdrawal symptoms
 
Symptoms of withdrawal are unpredictable; no one can tell who will get symptoms, which ones will occur, how long they will last, or how intense they will be. Some people report the experience of symptoms as uncomfortable, distressing and/or painful.
 
What symptoms are possible? Why are they unpredictable?
 
Because psychiatric drugs affect your nervous system -- the "operating system" of your body -- withdrawal symptoms can show up almost anywhere. They can be problems in

- Perception (vision, smell, hearing, etc.)
- Cognition (confusion, inability to concentrate, disorientation, depersonalization, etc.)
- Unusual and powerful emotions (melancholia, weeping, fear, anxiety, neuro-emotions, etc.)
- Physical pain (headache, migraine, tingling, muscle aches, skin burning, etc.)
- Digestive issues (diarrhea, gastroparesis, etc.)
- Sleep issues (most commonly insomnia and poor sleep)
- "Brain zaps" (a sensation of tiny, sharp electrical surges in the brain)
- Hypersensitivity to medications, supplements, or foods

and others (more information about symptoms).



#4 scallywag

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Posted 21 August 2016 - 06:15 PM

What’s involved in reducing my dose?
 
To taper safely, we suggest reducing dose by no more than 10% of your current dose. This means you’ll be taking dosages that aren’t available as a standard tablet or capsule from manufacturers.
 
The tasks of tapering are primarily

  • measuring non-standard dosage
  • taking doses regularly
  • monitoring one's dosing and symptoms
  • adjusting the taper according to symptoms (increase dosage, decrease decrements, taper more slowly, or taper faster)

 

Some people are willing and able to pay to have their doses made at a compounding pharmacy. Others create their non-standard doses on their own by either

These activities require painstaking focus and attention, and can be annoying, frustrating, and/or tedious.



#5 scallywag

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Posted 21 August 2016 - 06:16 PM

What do you mean by self-manage?

 

Dealing with this challenge requires a lot from you, the "taperer". You need to be able to

  • take responsibility for your decisions
     
  • exercise extreme patience
     
  • tolerate discomfort and uncertainty
     
  • communicate truthfully and responsibly about what is going on with you
     
  • identify when you require local, in-person support and then take real-life action to obtain it

 

Please carefully consider your ability to meet the challenges of tapering in the context of both your current wellness and life situation.



#6 scallywag

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Posted 21 August 2016 - 06:31 PM

Does how I quit affect whether or how I get withdrawal symptoms?

 

When you reduce or quit an antidepressant (or any psychiatric drug), you may experience withdrawal symptoms.

 

These actions increase the probability of severe or prolonged withdrawal symptoms:

  • Quitting "cold-turkey" increases the risk of intense and prolonged withdrawal symptoms.
     
  • Skipping or alternating dosages often triggers withdrawal symptoms. It is not a gradual enough transition for some nervous systems.
     
  • Taking doses irregularly at very different times of day can trigger withdrawal symptoms.

 

Small dose reductions, no more than 10% of current dose, held for at least 1 month appear to pose the least risk.



#7 scallywag

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Posted 21 August 2016 - 06:32 PM

Why do you suggest tapering so slowly?
 
Withdrawal symptoms can be distressing, debilitating, and even disabling. While medicine insists that withdrawal symptoms last only a few weeks, some people experience them for much, much longer -- months and even years.

You cannot know in advance if you will suffer severe withdrawal from psychiatric medications. Very gradual reduction is the only way to limit the risk and severity of withdrawal symptoms. To be safe, we advocate a gradual taper with an initial reduction of 10% of dosage, for 3-4 weeks.

The theory behind tapering is that it allows your body and nervous system to gradually adapt to the absence of the medication. For more detail, please read:  
Why taper by 10% of my dosage?



#8 scallywag

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Posted 21 August 2016 - 06:35 PM

How do I know it's withdrawal and not relapse?

 

Typically, in withdrawal symptoms such as melancholia, anxiety, and disorientation come in intense waves, sometimes only a few minutes long, which differentiates them from relapse of a psychological condition.

In withdrawal, symptoms are much more intense than the original psychological condition. People suffering from withdrawal often say things like

- "This doesn't feel like my depression."
- "I've never had symptoms like this before."
- "I feel very weird and not like myself."
- "I can't feel my feelings."

It's up to you to decide whether your body and brain are behaving "normally" as they did before you tried medication, or if you are feeling differently. No one else, not even a doctor, can determine this.



#9 scallywag

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Posted 22 August 2016 - 11:52 PM

Stages of withdrawal syndrome
 
1. Acute withdrawal syndrome
 

Symptoms may appear

 

... when you reduce the dosage of a medication. If symptoms are severe and do not fade in a few days, they are a sign your reduction in medication was too sudden. You might increase dosage slightly and reduce by a smaller amount next time.
 

... after you stop a medication. Because your body may not at first recognize the decrease of the drug, you may not recognize withdrawal symptoms for a few weeks or even months.

 

All medical sources agree: Reinstating the medication (at a reduced dosage) soon after quitting can reduce or eliminate withdrawal symptoms. You can then taper more slowly from that level of medication. The window when reinstatement may work for reducing withdrawal symptoms varies from individual to individual; immediate reinstatement is best. After time passes, it is less likely that reinstatement will help. Reintroducing larger dosages of the drug tends to make symptoms worse.

 
2. Post-Acute Withdrawal Syndrome
 

Symptoms may last for weeks, months, or years after you stop. Probably for the majority of people, withdrawal symptoms resolve in a few weeks or months. Others can suffer for years from prolonged withdrawal syndrome.

In prolonged withdrawal syndrome, symptoms come in waves with windows of feeling more normal. Gradually, windows increase in frequency and length. Recovery varies from individual to individual and can take months or years.

Generally, prolonged withdrawal syndrome is not recognized by medicine. You will find very few doctors to diagnose it and still fewer to treat it.



#10 Altostrata

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Posted 27 September 2016 - 10:49 AM

Keep notes on paper about your drug dosages and daily symptom pattern

 

A symptom pattern that occurs regularly over several days could mean the symptoms are from withdrawal, other adverse effects of drugs, or something else you do on a daily schedule.

 

In the course of discussion in your Introductions forum topic, you may be asked to keep notes on paper of your daily symptom pattern, including when you take your drugs, their dosages, and any symptoms.

 

What we need to see for every individual day over several days is:

- Time and dosage for drugs taken in morning
- Time and description of any symptoms in the morning
 
- Time and dosage for drugs taken in afternoon
- Time and description of any symptoms in the afternoon
 
- Time and dosage for drugs taken in evening
- Time and description of any symptoms in the evening
 
- Time and dosage for drugs taken in middle of the night
- Time and description of any symptoms in the middle of the night (such as waking)
 
And so forth. A diary, in chronological order, such as:
 
6 a.m. Woke and vomited
8 a.m. Took 2.5mg Lexapro
10 a.m. Had diarrhea
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Stomachache
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Headache got worse
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke with headache

 


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.