Altostrata

Why taper by 10% of my dosage?

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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://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-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
updated

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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
updated

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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.

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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.

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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

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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.

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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.

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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.

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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.

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How do you define obsessive thinking, primrose?

 

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

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For gradual tapering, many medications come in liquid forms or can be made into liquids http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-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
fixed text and updated

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Hi, floronet.

 

The same guidelines apply to benzos.

 

We're not experts in benzo tapering here. There are sites that specialize in going off benzos. You may wish to join this Facebook group

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Question-

 

Can you take existing pills to a compounding pharmacy and ask them to make it into a liquid? Say if I have 90 days worth of pills, can I take them there and ask them?

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No, you need a prescription telling the pharmacy what to do.

 

The pharmacy might sell you a liquid base, though.

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Just a quick question - is it common for people to require a longer tapering period than the time spent on the drug in the first instance?

 

For example - someone was on, say, paroxetine at 20mg for 2 months. Would they generally be more likely to get away with a 2 month taper rather than a 2 year taper? Just seems like if someone was on a drug for a couple of months then a 10% taper would just habituate their body to the drug even further?

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Unfortunately, anyone on a drug for more than a month is at risk for withdrawal syndrome.

 

Yes, you might well spend more time tapering off a drug than you spent on it at full dosage. The risk in going faster is that you might suffer full-on withdrawal syndrome even though you consider yourself a lightweight drug user.

 

The time spent tapering does not habituate your nervous system, it lets it accommodate gradually to decreasing dosages.

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This is all a process that DOES take time and more time than any of us want to take but there is plenty of hope.

 

The decades thing is a real possibility for many of us but because tapering is non linear ( somewhat unpredictable) there is always the possibility of slipping in a slightly faster taper based on your symptoms.

 

You may discover, for example, that one of your drugs would be ok to taper during the SAD season. Maybe not one year but during another. There is always that possibility. 

 

The unpredictability of this tapering business can also work in your favor. Just a ray of hope.

 

RU

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And as you get down with your drugs and doses you will feel better and better.  You will have your life back long before you

are off them completely. Don't give up chick, keep going and you will get there.

 

 

 

This is very true & so is everything else I've read here from MamaP.  

 

That is another huge ray of hope for you right now. You WILL feel better as you successfully lower your doses. Sometimes that can actually be a problem because it is tempting to speed up.

 

But in the beginning I too was skeptical, felt defeated & pretty hopeless... so I get it.

 

I actively tapered not last winter but the winter before and did ok. Last winter I decided to take a break and I'm glad that I did.

 

What will happen this winter remains to be seen. 

 

One has to take every little step that you take forward, including just realizing the drugs are negatively impacting you as a huge victory. Because every LITTLE step forward IS a huge victory.  

 

AND  a step backward can be viewed as a victory as well because with every step backward you have gained just a little more insight, a little more knowledge, your body has given you just one more clue as how to best approach the continuation of YOUR taper.

 

Your brain is your friend, not your enemy. I have HATED and hate mine often enough but I have come to terms with the fact that what I desire ( to get off of the drugs .. NOW because I feel better & better at lower doses) and what i NEED frequently aren't in sync. 

 

It's a little like tug of war:  sometimes you have to give in a little and brace yourself so that you can take a little plus some to gain ground. 

 

Hang in there and listen to MammaP... she knows of which she speaks!!!

 

RU :)

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This 10% tapering every 4-6weeks got me from 20mg to my present dosage which is 10mg.

 

This is the only way to get off anti d's.

 

Best advice ever.

 

Remember SLOW is the key.

 

Doctors never told me about the 10% rule.

 

They told me to cut the tablets in half and get off a drug that i had been on for years within a month. Lmao!

 

That didnt work out to good. So finding out about the 10% taper was amazing.

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If you've been on the drug for a month or more, you are still at risk for withdrawal syndrome.

 

Severe life-threatening adverse reactions call for a faster taper. Extreme adverse reactions justify cold turkey, though it may still take a long time to recover from withdrawal.

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Just found this, an updated paper from Dr. Healy on stopping antidepressants. Not sure why it's not listed as a link through his site. It came up in google search.

 

Here he is more specific in that he mentions the 10% approach, and alludes to the waves and windows of withdrawal. You may want to add this to your list of links in the why taper by 10% thread. 

 

https://rxisk.org/gu...How_to_withdraw

Edited by ChessieCat
fixed link

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I understand a lot of people on here are currently in the "Storm" of WD - some have CT'd , while others have tapered too fast but are still on their "Drugs".  The one clear thing seems that everyone eventually gets better. 

 

So once your stable on a certain dosage and you have given your CNS time to recover - can the remainder of your Tapering process be done as a background thing in your life with little effect on your day to day functioning? If done slow enough that is. . . 

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Hi Nick,

 

I think this is the ultimate goal and the reason why this site exists.  To inform and support us to come off the best way for our own brain/body and live our lives as we do.

 

The best way is to give our brains time to reconstruct backwards which is why 10% or slower tapering is recommended, with holds in between to allow our brains to adapt to the change.  Patience, listening to our bodies for signs that our brain is healing/reconstructing and holding.

 

I don't think there will ever be the perfect way to come off drugs as we don't live in a perfect situation and we have to deal with external influences over which we sometimes have little or no control, but we can make the choice about how we let them affect us, ie positivity.

 

I found these very helpful in understanding what is happening which in turn is helping me to accept and be patient:

 

Video:  Healing from Antidepressants: Patterns of Recovery

 

Brain Remodelling

 

And a description which is more detailed but easy to understand:  Best Description of Healing Process

 

CC

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There's me - my tapering is getting further and further into the background of my life.  In Feb of this year I thought I'd never leave my house again (due to severe adverse-effects from Effexor), and now I'm gardening again, visiting friends, going into town - even drove myself into Hamilton yesterday.  I'm having family here for Christmas, and thinking of joining a local trauma-response team. 

 

This has all happened since I found a low tapering amount - 0.4% weekly for four weeks, then a month's hold.  I may be able to increase that slightly over time, after plenty of settled time.   

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I'm sorry, Dr. Glenmullen has removed most of his files from the Web.

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It's me again. I have a question about the holds between the reductions. I have read quite a lot of materials here on SA, but for some reason this has not become 100% clear for me. I hope you don't mind my question.

Here we go (this is a hypothetical scenario):

 

If you make a reduction and let's say within a few days develop wd symptoms that you perhaps rate 6-7 points in intensity. Let's say you have already tried reducing several times once a month and you know the pattern of your symptoms. My question is: how long would you actually have to wait for the next reduction to be on the safe side? Should you expect the intensity of the symptoms to go back to 0 or is this utopical to expect in many cases? If 0 is not what you should be aiming for before you reduce again - what is it? 1-2? 4?

 

 

My question is derived from the "harm reduction" way of starting a taper Alto has described in this topic. It says that you should move your reduction up by a week if the symptoms are minor. I guess I'm also asking what that "minor" means.

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If you are getting severe withdrawal reactions lasting more than a few days after a reduction, your reductions are TOO LARGE. You should make smaller reductions.

 

It's possible you can make smaller reductions more often than every month, but you'll have to see what your symptom pattern is like over 3-4 reductions.

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I've just finished reading The Soft Landing Method by Benjamin Kramer. He recommends a taper of 1/2 of original dose for first three months. Then 1/4 of original dose second three months. Then 1/8 of original dose for third three months. He says that it takes three months for your brain to adapt.

 

Prior to reading this book, I've been following posted recommendations of a 10% taper. It can get confusing.

 

 

Thoughts?

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That advice from Benjamin Kramer's The Soft Landing Method is better than most.

 

Many people cannot handle the larger decreases he suggests. With those decreases, you may very well feel withdrawal for 3 months or longer. The taper we recommend gets you to more or less the same place, but more gradually. It is intended to produce minimal withdrawal symptoms, and take less time for your nervous system to adapt to each small change.

 

Many of the people posting on this site came here after they tapered too quickly or went cold turkey and started searching the Web for explanations of their symptoms. They started out with withdrawal syndrome problems. Once Humpty Dumpty falls off the wall, it's hard to put him together again, and these people may continue to have drug-related symptoms for quite a while.

 

We have many people who have done well with their tapers, but they have less reason to post continuously. And, tens of thousands of people read the topics in our Tapering forum and don't register here or post at all.

 

If you want to go off psychiatric drugs, the only way is to reduce the dosage one way or the other. The only questions are "How?" and "At what rate?" The 10% per month rate we espouse is intended to serve everyone, including those who are very sensitive to dosage decreases (in addition, a very small number of hypersensitive people find they need to taper even slower).

 

We acknowledge that there is a wide variation of tolerance for tapering. The taper should be tailored to the tolerance of the individual. If you are tapering, learned your symptom pattern, and want to go a bit faster, you might try reductions of 10% every 3 weeks instead of 4 weeks and, after a while, every 2 weeks instead of 3 weeks.

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Apologies for not seeing this before:

 

I have a bit of a complicated question...

 

Lengthening my taper plan by doing 10% or lesser drops also means more and more years on this awful poison. 9 more years from today is a LONG time... how do I know if the benefits of being on this longer and going at a snails pace means less damage on my brain and body than getting off sooner but not as slow?? A little conflicted about this. Would LOVE some advice.

 

The 10% per month taper schedule is intended to minimize withdrawal symptoms. Some people are very sensitive to reductions in dosage.

 

Withdrawal symptoms are not things you can just brush off, they're signals from your nervous system that something isn't right. It is possible to trigger withdrawal symptoms that are severe and last for years.

 

So the question is: Which is more important: To get off the drug quickly, or to minimize withdrawal symptoms?

 

Some people are taking drugs in dangerous combinations or are causing health problems. If you are having a serious adverse effect from a drug, such as liver damage, you may choose to go off sooner rather than later. The risk of withdrawal syndrome may be about equal to or even less than the health risk of taking the drug.

 

If you are not having a serious adverse effect, which would show up in blood tests or other physical tests, the risk of withdrawal syndrome is greater than the health risk of the drug. You would want to avoid withdrawal syndrome with gradual tapering.

 

There is no one-size-fits-all answer. Since the factors leading to a decision about tapering are individual, these questions are best asked and answered in your Introductions topic, where we can see much of your recent history.

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nz, your calculations are correct. I have revised post #1 to say

 

  • "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.

 

 

We cannot predict the jumping-off point, it's highly individual. To be safe, many people stop when the dosage is so low, they cannot divide the drug any further.

 

If you're using a liquid to taper, this can be 0.01 milligram (one-hundredth milligram).

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