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Why taper by 10% of my dosage?


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#1 Altostrata

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Posted 05 August 2011 - 12:43 PM

ADMIN NOTE This topic is a general discussion of the principle of tapering. For case-by-case consideration of what YOU should do, please put your questions in an Introductions topic.
 
Do not put those questions in this topic, because detailed discussion of YOUR particular circumstances will take it off track and make this topic difficult for others to follow. The moderators will move any questions about YOUR particular case to the Introductions forum. Thank you.
 
 
The 10% taper recommendation is a harm reduction approach to going off psychiatric drugs. We believe this conservative tapering method will cause harm to the fewest number of people.
 
The reason this site exists is because doctors are unaware of the greater safety of gradual dosage reduction, usually advise tapers that are too fast, do not sufficiently recognize withdrawal syndrome, and do not know what to do if it occurs.

 

According to the journal literature on antidepressant withdrawal syndrome, anyone who has been taking a drug for a month or more is at risk.

In a nutshell, the 10% taper method recommends a 10% dosage reduction every 4 weeks, with the 10% calculated on the last dosage. The amount of decrease is proportionate to the last dosage (not the original prescription) and keeps getting smaller.
 
(Those finding that this method too slow can always speed up by making 10% reductions more often. However, if you get withdrawal symptoms, your nervous system is telling you that you are tapering too fast.)

The 10% per month reduction method is recommended by

In addition, see this paper Meyer, 2004 Serotonin transporter occupancy of five selective serotonin reuptake inhibitors at different doses: an %5B11C%5DDASB positron emission tomography study.
discussion and full text here http://survivinganti...-concentration/
 
As our member Rhi said:
 


....
When you open the document go to page 4 and look at the charts. You will see that at lower doses you must taper EXTRA slow, not faster. At higher doses, when you cut 1 mg, it only reduces your receptor occupancy by a small amount; but from 1 mg down to 0 you drop from 20% occupancy straight down to zero!
 
That's why we say calculate your cuts based on 10% of your CURRENT dose. (Or a smaller percentage....
....

 
Rhi suggests printing this paper out and taking it to your doctor to show why it's important to taper very gradually.
 
Why decrease by such a small amount?
This is why:

The risk of severe withdrawal is so great for some people, a very conservative approach to tapering to protect everyone is called for.

Many people seem to be able to taper off psychiatric medications in a couple of weeks or even cold-turkey with minor withdrawal symptoms perhaps for a month or so. Doctors therefore expect everyone can do this. However, it seems a minority suffer severe symptoms for much longer.

It is unknown how large or small this minority is. You may very well be in it. You can't know how your nervous system will respond to a decrease in medication until you try it.

You won't know if you're in the unlucky minority until it's too late. It's a lot easier to taper slowly than to put your nervous system back together again after it's injured.

From reports of withdrawal syndrome all over the Web, those concerned about withdrawal syndrome have come to a consensus: Decreases of 25%, which are recommended by many doctors, are too large, with many people develop withdrawal syndrome. Thus, the recommendation of the more gradual 10% reduction.

But aren't withdrawal symptoms minor and transient?
Withdrawal symptoms represent neurological dysfunction. They are not normal and should not be ignored. Severe symptoms can be distressing, debilitating, or even disabling. If you get prolonged withdrawal syndrome, there is no known treatment or cure. You will have to cope with it until it goes away.

According to Joseph Glenmullen in The Antidepressant Solution, discontinuation should incur almost no withdrawal symptoms.

Some guides will suggest a trial decrease of 25% to start. If you get withdrawal symptoms, it is recommended to reinstate the original full dosage and taper more slowly from there.

Except -- it can take weeks to feel the full brunt of withdrawal symptoms from an initial drop. If you have already made two reductions from your original dosage, you will have reduced by about 50% -- and your symptoms may indicate substantial neurological dysregulation. You could be suffering quite a bit for a long time.

It's a Humpty-Dumpty situation. Once your nervous system falls off that wall, there's not much that can be done to put it together again.

It makes more sense to start slow, to protect your nervous system, and increase your rate of taper if you can find you can tolerate a faster withdrawal.

(NEVER ALTERNATE DOSAGES TO TAPER. IF YOU ARE SENSITIVE, THIS IS SURE TO SET OFF WITHDRAWAL SYMPTOMS.)

A 10% decrease lessens your risk
If you are a person who is sensitive to fluctuations in your dosage, you may be suffering quite a bit, and for these people, even if the original dosage is reinstated at this point, withdrawal symptoms may continue to be severe.

To save wear and tear on your nervous system, we recommend an initial drop of 10% and staying at that level for a month to see if withdrawal symptoms develop.

If they do, you may wish to reinstate and make smaller decreases at intervals of about a month. If you are sensitive, this can protect you from a great deal of pain and discomfort.

Can you taper faster?
If are not sensitive to a 10% drop, by listening to your body, you may be able to make 10% drops more often than every month.

Many people do fine with a faster taper. Are you one of them? You can't tell ahead of time.

It's best to go slowly at first to find out how you tolerate a reduction. Once you damage your nervous system with withdrawal symptoms, it can take a very long time to feel good again.

The 10% method protects everyone and you have the option of tapering faster if you can tolerate it.

Follow this harm reduction approach to starting your taper:

  • Initially, make a 10% reduction and hold there for a MONTH. It can take several weeks for withdrawal symptoms to emerge. Do that again the second month.
  • If you have very minor or no symptoms from these 2 reductions, you can try reducing by 10% (calculated on the last dosage, the amount of decrease keeps getting smaller) every 3 weeks. Do that twice. If no problems, reduce by 10% every 2 weeks. Do that twice.
  • If no problems after 4.5 months of very gradual reduction, you may be able to reduce by 10% every week.
  • If significant withdrawal symptoms appear, make smaller cuts or go slower. Listen to your body.
  • "Jump off" at the end when you are taking less than 98% of the original dose and reductions no longer cause any reaction at all.

Under this method, the fastest taper takes about 12 months.

MIND-UK's Coping With Coming Off Psych Drugs Guide explains it like this (on the Icarus Project Web site):
 

Allow enough time for your body to readjust to the lower dosage at each stage. You could start by reducing the dose by 10 percent, and see how you feel. If you get withdrawal effects, wait for these to settle before you try the next reduction.....At each stage, if you find the reduction too difficult to cope with, you can increase the dose slightly (not necessarily back to the previous dose) and stabilise on that before you continue.


What if I have to taper slower than 10% per month?
If you are very sensitive to dosage reductions, you may have to reduce by very, very small amounts, less than 10% per month, or hold for even longer than a month at a time.

Everyone is different; you'll want to do what's best for your nervous system. This can make tapering a project lasting years.

See the discussion about this here: The slowness of slow tapers


Edited by Altostrata, 28 September 2016 - 09:19 AM.
updated

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

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#2 Altostrata

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Posted 28 January 2012 - 10:14 AM

Also see Dr. Peter Breggin's 10% taper method from Your Drug May Be Your Problem: How And Why To Stop Taking Psychiatric Medications by Peter R. Breggin and David Cohen.

Please note that the 10% reduction method we recommend on SurvivingAntidepressants.org is a 10% reduction on your CURRENT dosage, not the original dosage of the drug.
 
If you have been tapering, you calculate the 10% on your last dosage. The amount of the decrease keeps getting smaller for the duration of your taper.

- If you started at 10mg, the first reduction would be 10% of 10mg, or 1mg, for a reduced dose of 9mg.

- Your second reduction would be 10% of 9mg, or .9mg, for a reduced dose of 8.1mg.

- Your third reduction would be 10% of 8.1mg, or .81mg, for a reduced dose of 7.29mg.

And so on.

This ensures that your nervous system is eased down a gentle 10% slope at every step of the process. It's important that drops become smaller, not larger, as you go. Once you find the rate at which you can comfortably taper, you don't want to jolt your nervous system with a larger drop than it can handle.

Mathematics whizzes may recognize that the 10% reduction formula is a geometric progression (asymptote) approaching but never equaling zero. At a very small dosage, likely less than 1mg, when reductions no longer cause any withdrawal symptoms, you may want to simply stop.

You will need to use your own judgment about your jumping-off point. Some people have found that, to avoid withdrawal symptoms, the final steps require reductions so tiny they cannot measure them, employing methods such as dipping a toothpick in a liquid solution to ease off in the final stages.


Edited by Altostrata, 20 January 2016 - 06:49 PM.
updated

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

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#3 strawberry17

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Posted 13 February 2012 - 03:11 AM

I saw this article shared on facebook and on "Beyond Meds", do you mind if I share on my Prozac withdrawal blog as well? It is an excellent article on how to taper properly and one that I'm following, I'm nearly down to 1.2ml and realise that I'm going to have to decide on a "jumping off" point soon.

*** Please note this is not medical advice,discuss any decisions about your medical care with a knowledgeable medical practitioner***





http://prozacwithdrawal.blogspot.com/

Original drug was sertraline/Zoloft, switched to Prozac in 2007.

Tapering from 5mls liquid prozac since Feb 2008, got down to 0.85ml 23/09/2012, reinstated back to 1ml(4mg) 07/11/2012, didn't appear to work, upped to 1.05ml 17/11/2012, back down to 1ml 12/12/2012 didn't work, up to 1.30ml 16/3/2013 didn't work, bumped up to 2ml (8mg) 4/4/2013 didn't work, reinstated Sertraline (Zoloft) 50mg, feeling better now. Been on the antidepressant merry go round since November 1998.


#4 strawberry17

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Posted 13 February 2012 - 11:42 AM

I don't think 1.2ml is the same as 1.2mg, according to my calculations 1.2ml = 5mg. So with my 1ml syringe I'm not sure what to do beyond 1ml, I can still go down to 0.90ml and then 0.80ml.

*** Please note this is not medical advice,discuss any decisions about your medical care with a knowledgeable medical practitioner***





http://prozacwithdrawal.blogspot.com/

Original drug was sertraline/Zoloft, switched to Prozac in 2007.

Tapering from 5mls liquid prozac since Feb 2008, got down to 0.85ml 23/09/2012, reinstated back to 1ml(4mg) 07/11/2012, didn't appear to work, upped to 1.05ml 17/11/2012, back down to 1ml 12/12/2012 didn't work, up to 1.30ml 16/3/2013 didn't work, bumped up to 2ml (8mg) 4/4/2013 didn't work, reinstated Sertraline (Zoloft) 50mg, feeling better now. Been on the antidepressant merry go round since November 1998.


#5 Altostrata

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Posted 13 February 2012 - 12:47 PM

Is the concentration of your liquid 20mg per 5mL? That would be 4mg in 1mL, or 4.8mg in 1.2mL. The 1mL oral syringe should have ticks at .02 (5 ticks between 10ths) or .01mL (10 ticks between 10ths). If yours doesn't, try to find Danish-made Baxa 1mL oral syringes, they're marked for .01mL. .01mL of a 20mg per 5mL concentration is .04mg.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#6 strawberry17

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Posted 13 February 2012 - 12:58 PM

Hi Yes the concentration is 20mg per 5ml. Just checked my syringes and they are marked with 10 marks between the 10ths so yes very finely marked. The maths does get quite tricky the lower you go :D

*** Please note this is not medical advice,discuss any decisions about your medical care with a knowledgeable medical practitioner***





http://prozacwithdrawal.blogspot.com/

Original drug was sertraline/Zoloft, switched to Prozac in 2007.

Tapering from 5mls liquid prozac since Feb 2008, got down to 0.85ml 23/09/2012, reinstated back to 1ml(4mg) 07/11/2012, didn't appear to work, upped to 1.05ml 17/11/2012, back down to 1ml 12/12/2012 didn't work, up to 1.30ml 16/3/2013 didn't work, bumped up to 2ml (8mg) 4/4/2013 didn't work, reinstated Sertraline (Zoloft) 50mg, feeling better now. Been on the antidepressant merry go round since November 1998.


#7 Altostrata

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Posted 13 February 2012 - 01:04 PM

Agreed! I give my calculator quite a workout.
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

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#8 InNeedOfHope

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Posted 16 February 2012 - 06:58 AM

I have a question. I have rapid tapered earlier on and seem unable to pull it back. Reducing only 2 beads a week is too much and so I am having to reduce by only 1. The thing is I worry that lower done culmulatively this will become too much as the % increases. Even doing tiny reductions means that when you get to a lower dose you have no choice but to reduce by higher % in a six week period. I can see this lasting for years for me and I dont feel I have the physical nor mental stamina. What doe people do when they get to these doses? How do they manage the pain and the symtoms? Does it get harder and harder the lower a person goes? I get so confused. I went from 60 to 30 and yes it was hell on earth. But I didnt use valium to ease the pain. The thing is at that time I had been on it for only 4 months and so in theory it has shut down only so much of my brain.So as bad as the pain was at that time I had no kidney, heart, nor other pain issues. Now I have shut down more it gets worse the lower I go. I get confused because the original psychiatrist says I could make things worse taking my time and putting more of this in my body. I can't seem to find anyone that is in the same position as me and what can be done about it. So I wonder do I keep going at 1 bead..knowing that I am putting more in my system,knowing I am putting off the inevitable by the time I get to 10mg....spending over a year getting there, knowing I will end up in an intolerable place? What would I do then? I feel that switching will cause other problems, it might not go smoothly, I could be left with damage from 2 drugs, sort of going ct on cymbalta and addding another med to withdraw from. I suppose my main question re 10% tapering is that at smaller doses there is no such thing as 10% of the dose. I can't even manage 5% at the moment. How does the fact that at small doses 10% is not possible especially with bead medicines? Is there anyone anywhere who has done it this way? Is there anyone who has gone too fast originaly and slowing down has caught them up? Please any ideas would be much appreciated, I am desperate. The thought of doing this for years for it all go go wrong anyway is just to much to bear.
Sept 2010 - Citalopram 1 day
Sept 2010 - Zopliclone for ten weeks (paranoia ended a couple of months after coming off this and sleep settled down again until the last couple of months)
Ocober 2010 - Cymbalta 30mg
November 2010 - Cymbalta 60mg
February 2011 - 60mg to 30 mg (lasted 10 days)reinstated 60mg
March 2011 - Took 2 60mg tablets on one evening in error - paralysis of face, back of head, shoulder, stabbing in right kidney, lost 30% of hearing)
March - June 2011 went down quickly 1mg a day until I got stuck at 25mg, went up to 27mg, because couldn't breath.
26th June - 26mg
3rd July - 25mg
17th July - 24mg
24th July - 23mg
7th Aug - began reducing by a bead every couple of days or so went well at first then hit a wall
24th October - now on 18.5mg. Since the kidney infection at start of September, have been in constant pain and anxiety, no let up. Given Ciprofloxacin.
8th Jan 2012 17.8mg (currently reducing 0.2mg a week)
8th Jan 2012 17.6mg last reduction was 6 days ago.
15th Jan 17.4mg
21st Jan 17.2mg

#9 Altostrata

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Posted 16 February 2012 - 10:16 AM

InNeed, a 10% reduction is suggested as a starting point. Some people find they cannot tolerate that amount of reduction and need to taper by smaller decrements. Some people, such as yourself, have a great deal of difficulty tapering by any amount. David Healy has discussed this. You're not the only one. Given that you can't divide Cymbalta beads, tapering by one at a time is the lowest you can go. It's true that as you go down in dosage, one bead represents a larger and larger percentage of the whole, but it's the best you can do.
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

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#10 Altostrata

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Posted 01 May 2012 - 09:29 AM

Summary of our harm reduction approach to tapering

It's best to go slowly to find out how you tolerate a reduction. Once you damage your nervous system with withdrawal symptoms, it can take a very long time to feel good again.

But -- many people do fine with a faster taper. Are you one of them? You can't tell. We advocate a harm reduction approach to tapering:

  • Initially, make a 10% reduction and hold there for a MONTH. It can take several weeks for withdrawal symptoms to emerge. Do that again the second month.
  • If you have very minor or no symptoms from these 2 reductions, you can try reducing by 10% (calculated on the last dosage) every 3 weeks. Do that twice. If no problems, reduce by 10% every 2 weeks. Do that twice.
  • If no problems after 4.5 months of very gradual reduction, you may be able to reduce by 10% every week.
  • If significant withdrawal symptoms appear, make smaller cuts or go slower. Listen to your body.

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.

#11 primrose

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Posted 28 September 2012 - 09:24 AM

Hello I am not new to tapering. I have been tapering valium for the last few years. I only understand tapering in the context of a benzo. Are the mechanisms of action the same for tapering an AD or an AP? I want to see if the process of tapering seroquel and trazodone is the same as tapering benzos.(tapering each drug separately of course and not while tapering benzo) I know different receptors are involved for each drug. We taper benzos in two ways. One is to cut no more than 10% of the dose and hold for as long as it takes to stabilise from that cut. (In most cases a few weeks)7 Benzos can be cut daily. A daily cut is decided upon by the user, if symptoms emerge then the cut-size is reduced. The daily taper is gentler because there is no sudden lopping off of a chunk and no sudden surge of symptoms because of this. The goal is to re-up regulate the GABA receptors so that they can begin working again, after having stopped working properly from benzo use. In tapering antidepressants, is it the same? Is the goal to re-upregulate the dopamine receptos? In tapering antipsychotics, is the goal to re-upregulate the dopamine receptors? In benzo tapering, the hold time is 2-3 weeks, why is it a month in antidepressant and antipsychotics? Has anyone tried micro-tapering these meds? Thanks

pregan taper 600mg down to 240mg, daily cuts since xmas

valium, just over 75mg, tapering 0.1 a day, will keep this more udated, cos amounts going down

i have borderline personality, chronic ptsd, and suspected adhd and substance misuse as a symptom, which i am addressing with help of medical staff, drugs agencies & mh sta


#12 Altostrata

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Posted 28 September 2012 - 01:12 PM

Great questions! Yes, the tapering principle is the same for non-benzo psych meds. Try a 10% taper, hold for a month (because withdrawal symptoms might take several weeks to emerge). It all goes well, another 10% taper for a month. If you're tolerating the 10% cuts well, you might go faster, making cuts every 3 weeks or 2 weeks. If you have trouble with the first or second 10% cut, you know you have to go slower, with smaller cuts. Yes, people do microtaper once they've found out what their tolerance and symptom pattern is.
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

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#13 primrose

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Posted 29 September 2012 - 05:16 AM

Great questions!

Yes, the tapering principle is the same for non-benzo psych meds. Try a 10% taper, hold for a month (because withdrawal symptoms might take several weeks to emerge). It all goes well, another 10% taper for a month. If you're tolerating the 10% cuts well, you might go faster, making cuts every 3 weeks or 2 weeks.

If you have trouble with the first or second 10% cut, you know you have to go slower, with smaller cuts.

Yes, people do microtaper once they've found out what their tolerance and symptom pattern is.

Hi Altostra and thanks.

I am a bit confused though and I have another question please.

The valium I am on has a 200hr long half life and this is why symptoms can take 2 - 3 weeks to show.

My trazodone only has a 3-9 hour half life and my seroquel has an half life of 6 hours (parent compound); 12 hours (active metabolite)
Why would it take several weeks for symptoms to show?

thanks

pregan taper 600mg down to 240mg, daily cuts since xmas

valium, just over 75mg, tapering 0.1 a day, will keep this more udated, cos amounts going down

i have borderline personality, chronic ptsd, and suspected adhd and substance misuse as a symptom, which i am addressing with help of medical staff, drugs agencies & mh sta


#14 Jemima

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Posted 29 September 2012 - 11:32 AM


I am a bit confused though and I have another question please.

The valium I am on has a 200hr long half life and this is why symptoms can take 2 - 3 weeks to show.

My trazodone only has a 3-9 hour half life and my seroquel has an half life of 6 hours (parent compound); 12 hours (active metabolite)
Why would it take several weeks for symptoms to show?

thanks


I don't know how benzos affect the brain, but what happens with the antidepressants that affect serotonin levels is that they actually change the structure of the brain, destroying some neurotransmitters and growing new ones, which creates abnormal brain functioning. When the drug is discontinued, it may take weeks for the brain to attempt to get back to normal, a process which can result in the strange and uncomfortable symptoms we call withdrawal. This is why it's so important to taper off antidepressants very slowly instead of yanking that chemical support of the nervous system away abruptly, and it's why withdrawal symptoms continue long after the AD is out of one's system. The brain takes its good old time getting back to normal.

Restoring brain function isn't a linear process. It seems to go in jerks forward and back, although a bit more forward overall and it can take months to years depending on the person's overall health and drug history. At this point, no one knows who is likely to suffer from protracted withdrawal and who can cold turkey with no harm done, so it's best to taper very gradually and slowly rather than take a chance on being miserable and disabled from withdrawal.

Psychotropic drug history: Pristiq 50 mg. (mid-September 2010 through February 2011), Remeron (mid-September 2010 through January 2011), Lexapro 10 mg. (mid-February 2011 through mid-December 2011), Lorazepam (Ativan) 1 mg. as needed mid-September 2010 through early March 2012

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Please note that I am not a medical professional and my advice is based on personal experience, reading, and anecdotal information posted by other sufferers.

 


#15 Altostrata

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Posted 29 September 2012 - 11:50 AM

primrose, you get withdrawal symptoms when your nervous system "notices" the absence of the drug. From the same drug, some people experience withdrawal symptoms immediately and some don't. Sometimes your nervous system "notices" but doesn't send up obvious alarms right away. This can be some time later than your last dose, even weeks or months as some people have found. Half-life means half the drug has been metabolized, as measured in the bloodstream. Smaller amounts of the drugs actually hang around longer than the half-life; this is usually estimated as 5 half-lives (and still a tiny amount remains, as it's a geometrical progression). Some drugs have active metabolites which extend the effect with their own half-lives, which you also have to multiply by at least 5.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#16 primrose

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Posted 29 September 2012 - 12:38 PM

I know that antidepressants act on serotonin receptors but benzos work the same way too, but on gaba receptors. They change these receptors somehow, and that is why those who taper by cutting bits off should wait a few weeks before cutting again. Benzos are worse than any drug to come off, including heroin. I have heard of people having long periods of withdrawal from benzos and know from personal experience what the withdrawals are like, but I have never heard of someone having long and protracted withdrawal of a similar length when coming off antidepressants or antipsychotics. Yes, they alter serotanin and dopamine receptors but benzos alter gaba receptors and there are loads in the brain. When my doctor brought me off mirtazapine she told me to take half one week and quarter the next if I needed it but I was fine. I had only been taking them for five weeks though.

pregan taper 600mg down to 240mg, daily cuts since xmas

valium, just over 75mg, tapering 0.1 a day, will keep this more udated, cos amounts going down

i have borderline personality, chronic ptsd, and suspected adhd and substance misuse as a symptom, which i am addressing with help of medical staff, drugs agencies & mh sta


#17 primrose

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Posted 29 September 2012 - 12:41 PM

primrose, you get withdrawal symptoms when your nervous system "notices" the absence of the drug.

From the same drug, some people experience withdrawal symptoms immediately and some don't. Sometimes your nervous system "notices" but doesn't send up obvious alarms right away. This can be some time later than your last dose, even weeks or months as some people have found.

Half-life means half the drug has been metabolized, as measured in the bloodstream. Smaller amounts of the drugs actually hang around longer than the half-life; this is usually estimated as 5 half-lives (and still a tiny amount remains, as it's a geometrical progression).

Some drugs have active metabolites which extend the effect with their own half-lives, which you also have to multiply by at least 5.

I plan to micro-taper my antidepressants and antipsychotics because I find micro tapering benzos much more smooth than doing a cut and hold type taper. The thing is I know my lag-time, so I can micro taper.
I found out my lag time when I did the cut and hold type taper of benzos, I found out how many days it took me for symptoms to hit.

How does one go about finding out how many days it takes for symptoms to hit when tapering anti depressants or anti psychotics if it takes months for them to hit?

pregan taper 600mg down to 240mg, daily cuts since xmas

valium, just over 75mg, tapering 0.1 a day, will keep this more udated, cos amounts going down

i have borderline personality, chronic ptsd, and suspected adhd and substance misuse as a symptom, which i am addressing with help of medical staff, drugs agencies & mh sta


#18 Jemima

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Posted 29 September 2012 - 01:35 PM

To my way of thinking, the idea is to avoid finding out when withdrawal symptoms hit by decreasing the AD dose by 10% or less, holding there until stable, and then reducing some more. If withdrawal symptoms occur, a small updose is in order along with holding until stable. This is a great deal more art than science, but it's the best we've got. Because withdrawal varies so much with individuals, it's important to listen to one's body and do what is most comfortable.

Psychotropic drug history: Pristiq 50 mg. (mid-September 2010 through February 2011), Remeron (mid-September 2010 through January 2011), Lexapro 10 mg. (mid-February 2011 through mid-December 2011), Lorazepam (Ativan) 1 mg. as needed mid-September 2010 through early March 2012

"Never attribute to malice that which is adequately explained by stupidity." -Hanlon's Razor


Introduction: http://survivinganti...oducing-jemima/

 

Success Story: http://survivinganti...r-dickhead-too/

Please note that I am not a medical professional and my advice is based on personal experience, reading, and anecdotal information posted by other sufferers.

 


#19 Altostrata

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Posted 29 September 2012 - 01:41 PM

As Jemima said, a trial taper of 10% can help you establish your tolerance for dosage reduction. We suggest holding a month to see if any symptoms show up; if not, do it again for another month. If no symptoms, you know you might be able to make 10% cuts more often and you can establish your own rate of taper. However, micro-tapers might work fine for you if you can manage the details. I would not try to predict antidepressant withdrawal patterns from prior experience tapering benzos. There are differences, plus you'll have the imprint of the benzo withdrawal (and withdrawal symptoms) on your nervous system. This can make it more vulnerable to withdrawal symptoms.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#20 primrose

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Posted 29 September 2012 - 02:30 PM

To my way of thinking, the idea is to avoid finding out when withdrawal symptoms hit by decreasing the AD dose by 10% or less, holding there until stable, and then reducing some more. If withdrawal symptoms occur, a small updose is in order along with holding until stable.

This is a great deal more art than science, but it's the best we've got. Because withdrawal varies so much with individuals, it's important to listen to one's body and do what is most comfortable.

But how long do you hold for, if symptoms take months to come on?
You could hold for a month, thinking all is well and then a month later symptoms from the first cut hit.
With benzos, many cut and then take a week to a month to stabilise and then cut again.
With benzos, symptoms dont suddenly appear after a few months.

Is there a special way to withdraw for each med or group of meds.
I mean, antidepressants can be ssri, maoi, snri, tricylic, etc etc then you have your antispychotics, which are different again.
Is this 10% a month thing standard for all non benzo psych meds?
This seems strange as the science would be different for each individual substance, and similar for each group, i.e. the ssri's etc.

Sorry for all the questions I am knowledge hungry :)

pregan taper 600mg down to 240mg, daily cuts since xmas

valium, just over 75mg, tapering 0.1 a day, will keep this more udated, cos amounts going down

i have borderline personality, chronic ptsd, and suspected adhd and substance misuse as a symptom, which i am addressing with help of medical staff, drugs agencies & mh sta


#21 primrose

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Posted 29 September 2012 - 02:33 PM

As Jemima said, a trial taper of 10% can help you establish your tolerance for dosage reduction. We suggest holding a month to see if any symptoms show up; if not, do it again for another month. If no symptoms, you know you might be able to make 10% cuts more often and you can establish your own rate of taper.

However, micro-tapers might work fine for you if you can manage the details.

I would not try to predict antidepressant withdrawal patterns from prior experience tapering benzos. There are differences, plus you'll have the imprint of the benzo withdrawal (and withdrawal symptoms) on your nervous system. This can make it more vulnerable to withdrawal symptoms.

Can I just clarify?
You cut 10% and wait a month, if no symptoms, you cut again and repeat, until you get symptoms and may need to hold longer or reduce the cut?

I was paranoid that my withdrawal from my non benzo meds would be worse, but I am not going to even go there.
If I taper safely enough, there should be no withdrawals.
I only got benzo withdrawals from doing a cold turkey.
I think withdrawal symptoms happen only if we taper too quick.

pregan taper 600mg down to 240mg, daily cuts since xmas

valium, just over 75mg, tapering 0.1 a day, will keep this more udated, cos amounts going down

i have borderline personality, chronic ptsd, and suspected adhd and substance misuse as a symptom, which i am addressing with help of medical staff, drugs agencies & mh sta


#22 Jemima

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Posted 29 September 2012 - 02:52 PM

Can I just clarify?
You cut 10% and wait a month, if no symptoms, you cut again and repeat, until you get symptoms and may need to hold longer or reduce the cut?


Or updose - slightly - to reduce the symptoms, hold again, and perhaps decrease the dose somewhat less the next time.


I was paranoid that my withdrawal from my non benzo meds would be worse, but I am not going to even go there.
If I taper safely enough, there should be no withdrawals.
I only got benzo withdrawals from doing a cold turkey.
I think withdrawal symptoms happen only if we taper too quick.


Bingo. :)

Psychotropic drug history: Pristiq 50 mg. (mid-September 2010 through February 2011), Remeron (mid-September 2010 through January 2011), Lexapro 10 mg. (mid-February 2011 through mid-December 2011), Lorazepam (Ativan) 1 mg. as needed mid-September 2010 through early March 2012

"Never attribute to malice that which is adequately explained by stupidity." -Hanlon's Razor


Introduction: http://survivinganti...oducing-jemima/

 

Success Story: http://survivinganti...r-dickhead-too/

Please note that I am not a medical professional and my advice is based on personal experience, reading, and anecdotal information posted by other sufferers.

 


#23 Altostrata

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Posted 29 September 2012 - 03:00 PM

There's no special way to taper each class of drugs. There is a wide range of reactions to decreasing dosage. Some people can cold turkey with no problem. Others do fine with a taper of a few weeks. Medicine's assumption is that most people can go off drugs that quickly. However, you can't predict whether you'll be in the lucky majority or unlucky minority. To be safe -- and not inconvenience the majority too much -- we suggest a 10% reduction and holding for a month at least twice to catch most withdrawal problems. Peter Breggin established the 10% rate through trial and error, and peer support groups have confirmed it is a safe rate. Only the most sensitive people should have problems with this trial taper, and they'll know it within the 2 months. People who report withdrawal symptoms after some number of months invariably have not tapered at 10%. This is not a well-known technique. Sometimes people have withdrawal symptoms within a couple of months but don't recognize them, they think it's something else, stress or the flu. Doctors will tell them they don't have withdrawal symptoms. After a while, the symptoms culminate and, after a little (or a lot of) research, they realize they have withdrawal syndrome. So the 10% trial reduction for 2 months is a way to test whether it's too fast, too slow, or just right for you.
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

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#24 primrose

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Posted 18 October 2012 - 02:54 PM

I've just come back on here to report on my progress. I was really pleased to see the back of the sweats when I started taking 45mg quetiapine every 8 hours rather than 67.5mg every 12 hours. Then, two days ago, they came back. I don't know why. Maybe it's the way I divide my 25mg seroquel pill to get 20mg. (I take one 25mg pill and 20mg every 8 hours) I get a small 100ml jar and squirt 50ml in it using my 50ml syringe. I drop one 25mg seroquel pill in and wait for it to dissolve. It forms a little pile of powder on the floor of the jar. I give it a really good hard shake and then, quickly as I can, because seroquel is not fully soluble, http://www.drugbank.ca/drugs/DB01224 and the particles drop down to the bottom of the jar, the moment I stop shaking it, I plunge my 50ml syringe in and draw 10ml off. I don't use the 10ml, because, despite all of the tricks to get rid of bubbles, I cannot, I find it easier to use the 50ml, draw some liquid off, squirt 10ml down the drain, and squirt the rest back in the jar, to make 40ml, or 20mgs. I really thought I had seen the back of the sweats. I also did not seem to have any withdrawal symptoms from dropping the 15mg, and would be quite surprised to see symptoms suddenly pop up after a week. The drugs half life is short, so I would imagine any symptoms would have shown them selves by now.

pregan taper 600mg down to 240mg, daily cuts since xmas

valium, just over 75mg, tapering 0.1 a day, will keep this more udated, cos amounts going down

i have borderline personality, chronic ptsd, and suspected adhd and substance misuse as a symptom, which i am addressing with help of medical staff, drugs agencies & mh sta


#25 Altostrata

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Posted 18 October 2012 - 03:31 PM

Are you using a 5mL syringe rather than a 50mL syringe? Your procedure looks correct. Yes, you might be having mild withdrawal symptoms after a week. Perhaps you should slow down and hold on your taper for a bit here.
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

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#26 primrose

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Posted 18 October 2012 - 04:27 PM

Are you using a 5mL syringe rather than a 50mL syringe?

Your procedure looks correct.

Yes, you might be having mild withdrawal symptoms after a week. Perhaps you should slow down and hold on your taper for a bit here.

Hi and thanks

I use a 50ml syinge.
I cut last tuesday so find it odd that withdrawals would come now, especially as the drug is only short half life.

pregan taper 600mg down to 240mg, daily cuts since xmas

valium, just over 75mg, tapering 0.1 a day, will keep this more udated, cos amounts going down

i have borderline personality, chronic ptsd, and suspected adhd and substance misuse as a symptom, which i am addressing with help of medical staff, drugs agencies & mh sta


#27 Altostrata

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Posted 18 October 2012 - 05:51 PM

I think we discussed this before. Half-life is not entirely predictive of withdrawal symptoms.
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

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#28 primrose

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Posted 19 October 2012 - 01:45 AM

I think we discussed this before. Half-life is not entirely predictive of withdrawal symptoms.

Thanks, but where is the evidence or source information to show that it is possible for withdrawal symptoms to start up after a week?

thanks and sorry for the need to clarify

pregan taper 600mg down to 240mg, daily cuts since xmas

valium, just over 75mg, tapering 0.1 a day, will keep this more udated, cos amounts going down

i have borderline personality, chronic ptsd, and suspected adhd and substance misuse as a symptom, which i am addressing with help of medical staff, drugs agencies & mh sta


#29 Altostrata

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Posted 19 October 2012 - 08:49 AM

1) Your own experience. 2) The experiences of hundreds of people who have posted on this site.
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

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#30 primrose

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Posted 20 October 2012 - 06:16 AM

But I'm not convinced it is withdrawal cos I was sweating even before I started cutting and I stopped sweating for two days. I can see why there is a lag time with valium, and I know seroquel is not a benzo, but why would I improve for two days then get worse? I had two blood tests yesterday, one for thyroid function, and the other, because a blood test I took in January came back with slightly elevated white blood cell count and the doctor wants to check that there are no problems now. I know withdrawal is very sensitive, and we must take great caution, given how it can affect some people, and it can seem like everything affects everything else, but from my own long term benzo withdrawal experience, I also know that obsessive thinking can make us afraid to eat, do or drink hardly anything. That was my experience. I was scared to cut my dose and mainly ate peanut butter sandwiches, and potato carrot and tuna, repeatedly for a long time.

pregan taper 600mg down to 240mg, daily cuts since xmas

valium, just over 75mg, tapering 0.1 a day, will keep this more udated, cos amounts going down

i have borderline personality, chronic ptsd, and suspected adhd and substance misuse as a symptom, which i am addressing with help of medical staff, drugs agencies & mh sta


#31 alexjuice

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Posted 20 October 2012 - 08:44 AM

How do you define obsessive thinking, primrose? I agree that one of the challenges is maintaining a balance between vigilance and obsessive overanalysis.

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman


#32 primrose

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Posted 20 October 2012 - 09:26 AM

How do you define obsessive thinking, primrose?

I agree that one of the challenges is maintaining a balance between vigilance and obsessive overanalysis.

By becoming obsessed about what I eat, or do, and the effect it will have on my withrawal. Letting it take over my life.

pregan taper 600mg down to 240mg, daily cuts since xmas

valium, just over 75mg, tapering 0.1 a day, will keep this more udated, cos amounts going down

i have borderline personality, chronic ptsd, and suspected adhd and substance misuse as a symptom, which i am addressing with help of medical staff, drugs agencies & mh sta


#33 MountainMan

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Posted 20 February 2013 - 10:30 AM

Of course, it's not always so easy to get an exact 10% reduction in dosage when the medicine is in tablet form. Also, at what point does the 10% suggestion end? What I mean is, if someone is taking 150 mgs of medicine A, a 10% reduction would take it to 135 mgs. But say at some point the patient is taking 25 mgs. Should the reductions continue at 10% even at this point? At this rate, not only would it continue to be difficult to get accurate dosages, but the dosage would just go on forever at a number approaching zero but not quite getting there.

#34 Altostrata

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Posted 20 February 2013 - 10:35 AM

For gradual tapering, many medications come in liquid forms or can be made into liquids http://survivinganti...ts-or-capsules/

The reduction continues at 10% on the last dose even down to fractions of a milligram. It is asymptotic, approaching but never equaling zero. When to jump off is an individual judgment call based on your symptom pattern. If you get withdrawal symptoms at every decrease, no matter how small, you will want to cut the last bit even finer (and hold more frequently).

For safety, depending on sensitivity to reductions (you can tell what your symptom pattern is), an individual may quit somewhere less than 1 milligram for antidepressants, which are generally dosed in the hundreds of milligrams.

Tapering other drugs dosed in the tens of milligrams or single digits (Abilify, benzos, etc.) involves decreases of hundredths of a milligram and may end at a tiny fraction of a milligram.

Edited by Altostrata, 14 January 2014 - 04:11 PM.
fixed text and updated

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

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#35 MountainMan

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Posted 20 February 2013 - 12:53 PM

The link is very interesting but requires a lot of work and effort. I don't mind work and effort but the more steps there are, the more, I worry, that could go wrong. You've told me that there is a liquid form of Zoloft but I figure it'll be near impossible to convince any doctor to prescribe this. I'm also taking Mirtazapine. By the way, I'm also taking Coumadin at this time for the blood clots in my lungs many months ago and wonder if that has any bearing on the tapering process.

#36 Meimeiquest

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Posted 20 February 2013 - 01:16 PM

How often do you have your blood levels checked for your Coumadin therapy?
1st round Prozac 1989/90, clear depression symptoms. 2nd round Prozac started 1999 when admitted to dr. I was tired. Prozac pooped out, switch to Cymbalta 3/2006. Diagnosed with bipolar disorder due to mania 6/2006--then I was taken abruptly off Cymbalta and didn't know I had SSRI withdrawal. Lots of meds for my intractable "bipolar" symptoms.
Zyprexa started about 9/06, mostly 5mg. Tapered 4/12 through12/29/12
Wellbutrin. XL 300 mg started 1/07, tapered 1/18/13 through 7/8/13
Oxazepam mostly continuously since 6/06, 30mg since 12/12, tapered 1.17.14 through 8.26.15
11/06 Lithium 600mg twice daily, 2.2.14 400mg TID DIY liquid, 2.12.14 1150mg, 3.2.14 1100mg, 3.18.14 1075mg, 4/14 updose to 1100mg, 6.1.14 900 mg capsules 7.8.14 810mg, 8.17.14 725mg, 8.24.24 700mg...10.22.14 487.5mg, 3.9.15 475mg, 4.1.15 462.5mg 4.21.15 450mg 8.11.15 375mg, 11.28.15 362.5mg, back to 375mg four days later, 3.4.16 updose to 475 (too much going on to risk trouble)
9/4/13 Toprol-XL 25mg daily for sudden hypertension, tapered 11.12.13 through 5.3.14, last 10 days or so switched to atenolol
7.4.14 Started Walsh Protocol
56 years old