triplem15

triplem15: Weaning Bupropion

165 posts in this topic

Or... Do you think I would be suitable for your slide??? Not sure if the metabolites and time are an issue or not??? Does Paxil have a delayed clearing of metabolites??? What are your thoughts???

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Hi MMM--- no you only need one scale.  They are referred to as a set because in the old days they were made up of several parts that had to work together, so you had a "set of parts" or a "set of scales".  Most of us use the Gemini-20 that you can get from amazon.com for about $30.  If you order one also get a big bag of "0" or "1" gel caps.  They will make making up your dose a lot easier.

 

Tapering at 10% is our general recommendation for the fastest some people can go.  It frequently is to fast for a lot of people.  Starting at 5% is a good idea, see how you react and then make adjustments from there.  The Brassmonkey Slide can be adjusted also.  So if you wanted to stick with a 5% total taper you could do 1.25% a week for four weeks and then hold or maybe 2.5% every two weeks and then hold an extra two weeks.  The whole idea is to work out a method that you feel comfortable with. Like you said "doing it and monitoring effects".  There are a number of people here using the Slide Method or a modification and all of them are doing very well with it. The whole idea behind it is to reduce the symptoms of taking a big drop but still try to keep the time frame of the big drop. I think you will probably do quite well with some form of it.

 

If it takes two weeks for your symptoms to show up, then I would not try to speed things up by doing a smaller drop in a quicker time frame.  Symptoms are the manifestation of the healing that is going on in your body and that healing needs to be given enough time to settle down before the next drop.  Otherwise the unfinished business adds up and after a few drops it can cause a crash.  That crash will take a lot of time to recover from and can be very painful.

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Hi Brassmonkey. Thank you for your input. I appreciate you and all the others on this site who have helped me. Now, I do have the Gemini 20. It is the scale I bought off of Amazon. I weighed 4 different pills and they all were different in weight. I averaged the 4 and the average weight is 467mgpw. The pill is 75 mgAI. On the previous note where I told you the mgpw, that was in Grams. So now Brassmonkey, will you help me go from here? Yes, the crash, that is precisely what happened to me when I found you all here at SA. I am so grateful I did. So, now I am building steady and yes, it has been hard. All the reason for why I want to get good and steady before going at the taper again. This time when I taper, I want to be safe and go at the sites recommended rate but starting at 5 percent to see how it goes initially. I won't lie, it scares me to think of tapering again at some point after feeling the way I have. Yes, noticing improvements, small but coming, but not where I would like to be. Going to hold tight for some time. As you said, as long as it takes!!!!

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Another question. I will order the capsules but, am I crushing the pills? And if so, how do you recommend doing this so as not to lose drug?

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I forgot that you mentioned earlier that you had bought the scales. Those are the numbers we need to work with; average weight of a pill 467mg and the strength 75mg.

 

Your current daily dose is 18.75mgai. Which you divide in two taking 9.375mgai in the morning and 9.375mgai in the evening. This makes your daily dose 1/4 of a pill and the dose you actually swallow 1/8 of a pill twice a day.

 

Daily dose; 465mgpw / 4 = 116mgpw  or 75mgai / 4 = 18.75mgai

Swallowed dose; 465mgpw / 8 = 58mgpw taken twice a day. or 75mgai / 8 = 9.375mgai taken twice a day.

 

You are proposing doing a 5% reduction.  We recommend taking each reduction off of the previous dose not the original dose.  In this way you get a smaller reduction each time which should yield gentler symptoms. It takes longer to do the taper but the symptoms are much, much more manageable this way.

 

We need to actually weigh the dose in mgpw because that's how the scales work. So your previous does would be 116mgpw. To calculate the new daily dose we do this: 116mgpw X 0.95 = 110mgpw. That then needs to be split in two to determine your swallowed dose: 110gpw / 2 = 55mgpw.

 

You could also work directly with the weight of your swallowed dose. 58mgpw X 0.95 = 55mgpw.

 

To figure the dose in mgai just use the same calculation 9.375mgai X 0.95 = 8.9mgai.  You use this for additional record keeping and discussing your dose in posts.

 

Next time you want to do a reduction you would use the same calculation but start with the new previous dose of either 110mgpw or 55mgpw.  55mgpw X 0.95 = 52mgpw.

 

I find it is very easy to crush the pills between two spoons.  It takes a little practice but works really well.  I work over a sheet of paper to catch any bits that fall out, but there usually aren't many.  I then keep the powder in a small container and scoop it out to weigh with the end of a nail file. Once I weigh it out I tip the pan onto a smaller piece of paper that has a fold down the middle and use that to pour the powder into the gel cap. If you dust the paper with a little powder first then you don't have to worry about loosing any by it's sticking to the paper during the transfer.

 

Hope that all makes sense, ask any questions that come up.

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Although you two know your abbreviations, I thought I'd define the acronyms for anyone else who's fully or partly mystified. I know I was. ;)

 

mgpw = milligrams (mg) pill weight: the number of mg the pill itself weighs

 

mgai = milligrams (mg) active ingredient: the number of mg of the active ingredient, e.g. paroxetine (Paxil), or escitalopram (Lexapro)

 

#acronym   #definition

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Thank you Brassmonkey. I will write all of this out. You have been and continue to be a great help. I will also continue to ask questions. Skallywag, thank you for clarifying the abbreviation for others who may be following.

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Mods, Neuro emotion, does this eventually level off to normal as adjusting continues??? I have read Jan Carols beautiful piece about thecalifornia cliffs and I am working mindfulness and meditation but, does this eventually return to a normal???

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Just want to express frustration. I, through this process have come into contact with several people I work with that are on one SSRI or another. They all experience undesirable side effects of the meds, yet, they believe the providers who hand them out like candy, often with NO real diagnosis. I am saddened by this. What an absolute abuse of these meds. All of these people I have talked with just believe the big pharma, the Providers and just don't question it. Yet, the negative side effects are present. I have also found through listening that when they question their side effects to the providers, the providers just want to increase the doses. One gal said to me yesterday, " What if I have a chemical imbalance?" I did ask her if she had a diagnosis when she went on?? She told me no, she asked for something. Now, I know that meds have a place but what are your thoughts about the volume of folks on these meds?? Something like one in ten Americans are on one. To me this is terrible abuse!!! Wonder if I can get some feedback.

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Triplem-wow. You and j are in the same boat right now except I'm not having Windows and waves!! Just hell on earth still. Glad to see someone making some progress!

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Nikki, you have gone way too fast on the ups and down doses!!! Stay put on a dose. The mods have all told me this and I have done so. Stay put. I intend to sit here for a good long time. In five days it will be 3 months on this dose. All I can tell you is what they have all told me, you need the stability. I do too and I'm not moving by the grace of God. I am trusting that with every day that passes, it will just improve. I work on mindfulness daily. Deep breathing and it helps. I also am a believer and my faith is very important. Sit still on a dose. Just sit!!!!

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Nikki, you need the advice of the mods. Did you get it????

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Yes they have been wonderful. Just can't get stable!

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Nikki. You will but you have to sit on the same dose. It is hard. You go moment by moment. You stay on the same dose. It has taken me three mos and I am still working at stable. Do not flip doses Nikki. Your neurology needs steady dose to build stable. This is moment by moment , one day at a time. It is hard but we must be patient!!!

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I know I'm very quick to react. Maybe j should lock up all pills so I can't change anything! Seriously though, I need to do that lol.

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Hi Nicki-- locking up the pills isn't a bad idea.  Go to a health food store and get some "0" or "1" size gel caps and then make up a months worth of pills at your current dose.  Keep those handy for your daily dose and lock your main supply in a safe place until you need to make up more doses next month.  Getting stable on a set dose is the most important thing you need to do right now.  This sort of preplanning should help.

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I now have a question. Brassmonkey and others have referred to withdrawal normal. Can this be elaborated on. I am soon, in two days going to be at the three month mark since my RI. I do not believe I am where I need to be to even consider tapering. Though I am just really now beginning to see more steady, not there. When steady, are waves and Windows still present?? Brassmonkey said to me it is an ok day after day after day. Well, I still do not think I am there. Waves seem some less intense and ? Probably getting shorter but as I am , no tapering in sight. So, please, what do I expect in withdrawal normal??? Right now, I am still very sensitive to loud and noisy. Still do not tolerate heat, and still feel a lot neurologically as far as symptoms. Some getting way better, others just lighter. Even some new as time goes by.

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Hi MMM--  here's a copy of what I have posted on my thread about WDnormal.

 

I see WDnormal as the overall baseline of where you are in general. The place you are when you're not feeling good, but you're not feeling bad. Sorta a rolling average of the past couple of months between the windows and waves.  Watching the level of WDnormal is a good indicator that things are improving.  Over time you should be seeing a raising of the standard for WDnormal.  So how you're feeling now is better than say six months ago. It changes very slowly but is a really good indicator.

 

 Many people have the idea that stability is feeling good again, when in fact it's feeling the same level of blah day after day with no big swings to the better or bad. When a person does a drop in dose there will be a corresponding increase in WD symptoms over the next few days.  These symptoms will resolve themselves over the following several weeks and return the person to a slightly raised baseline of discomfort. The time frame and severity are dependent on a huge number of factors and end up being unique to each individual.  But the pattern remains.  This is why paying attention to your WDnormal is very important.  It is also referred to as listening to your body.  After a drop in dose and the symptoms have resolved to WDnormal the person then should wait a couple of more weeks to let things really settle out (there are a lot of little unfelt changer still going on) before considering doing their next drop.

 

During that waiting time people may think that they're not doing anything and want to get on with it.  When in fact doing nothing is very proactive.  It's those little unfelt things that need to be finished up before the next step can be taken.  It's letting the glue harden, the paint dry, the cement cure.  The things that need to be complete before the path is safe to walk on again.  If these details are ignored then they start to pile up and compound each other, then somewhere down the line the foundation slips out from under us and the whole thing collapses.

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Brassmonkey, thank you. Again, you have been very helpful. Am I understanding this correctly, six to eight weeks is sufficient for the settling? For most people ? And, are you saying that the further we progress in the tapering and recovery, providing we allow all the needed time for adjusting, the WDnormal baseline improves, or gets better each time and over time?? Again, providing we are tapering at no greater than 10 percent, and maybe less, pending how we feel.

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I am also wondering if the Neuro emotion is settled in WDnormal???

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That's pretty much correct MMM.  SA recommends holding a MINIMUM of 4 weeks between drops. In my experience and from observations here and at Prior Place, six to eight weeks works better for most people.  The four weeks is a best case scenario.  WDnormal doesn't usually improve with each drop, but yes it steadily improves over the course of the taper.  At the beginning there is so much that needs to be improved that it's hard to see any changes for the better. It was probably 6 months and several drops before I started to see my first WDnormal improvement.  I tend to average the feelings for the last three or four months to establish it.

 

Over time and the lower the dose the quicker theWDnormal baseline will rise, because more and more healing has taken place and less and less drug is present to cause trouble. It is all predicated on doing a slow, controlled taper, being careful with supplements, being good to your self and practicing all the things we talk about here. This still applies if you throw in the complications of polydrugging, which just makes the improvements harder to see, or with reinstatements. The reinstatement has to be settled in before any baseline can be established, but a successful reinstatement can be considered an improving of the previous baseline in a manner of speaking.

 

Neuro-emotions are a symptom and can come and go through out a taper and recovery.  As the taper proceeds they tend to be less frequent and less intense, but follow the windows and wave pattern.  Also as the taper proceeds a persons skill at handling them should be improving.  All of which lends to an  improvement of the WDnormal level.

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Ok, thanks again Brassmonkey????????????

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Ok Brassmonkey, so would I be correct in saying, the longer I stay at this current dose of 18.75 mg, the stronger I should become , because I am allowing my Neuro to adjust and heal???

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That's the premise that we work on. The longer the hold the more stable and the more healing. Remember though that healing can't be complete until all the drug has been removed, so at some point the taper needs to be resumed. 

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I understand, thank you for your help.

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I will be forthright and honest, this last event, of destabilizing, really frightened me and I just want good and steady before I continue onward.

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As I think on all of this I have another question, has altostrata, or you Brassmonkey or anyone ever thought to write a book about antidepressant discontinuation???? It is needed so desperately.

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Hello. I need some help. I am trying to understand why or what is it??? Obsessive scarey thoughts!!! Intrusive and frightening!!! 3 months in to my RI and seems worse now. No dose change. Staying put. What is happening??? I think it is readjusting, then I am fearful and think it's me. Produces a lot of anxiety and fear. Please advise on this.

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triplem:  Have you been keeping notes of the timing of your dose and symptoms?

 

It seems as if this is a new symptom. Please correct me if my conclusion is wrong.

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Hi Skallywag, Truthfully, I believe this is anxiety driven!!!! 25 years ago, I struggled some with heavy anxiety and obsessive thought, this was years before I ever took any medication. . It seems worse now because of the intensified Neuro anxiety and fear. I am not sure but the anticipation of the Neuro emotion, produces a lot of anxiety for me. The fears, the what if's, really start to set in. Then when I am in a wave, of course the emotion is intensified. I feel a dread just anticipating the waves. I am also trying to figure out how to come to accept my life as it is. Since withdrawal, it has changed everything and not at all what I was expecting to have happen. Trying to find a way to make peace with the whole ordeal.

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I have also read that tapering bupropion can exacerbate anxiety. However, I am inclined to believe it happens from all of the meds!!!!

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Yes, I take good notes. The anxiety has been present all along just varying degrees.

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Truthfully, I am afraid. It is taking longer than I had hoped to stabilize. I am making progress but ever so slowly. Wondering if it is ever going to happen thinking going on. I know everyone says I will stabilize eventually.

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"What if" thoughts are one of the major symptoms of WD and one of the harder ones to control.  I found that changing it to just "if" really helped. It drops the worry factor and changes it into an action.

 

For three months into an RI this sounds pretty normal. This is a frustratingly slow process, but you're making good headway. If your level of anxiety is fairly constant then it can be counted as WDnormal.  The anxiety will just be there at that level so it can be ignored or worked around as you go on with more important things.

 

(((((((((((((((((HUGS)))))))))))))))

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Brassmonkey Tom, I just want to hug you right back!!!! Thank you. In Windows it is better. Then out of the blue, boom. In waves, it can be so difficult!!! irrational fears and thoughts!!! I am thankful you have again responded, I appreciate you and the others so much!!! I am holding!!!! I am really waiting this out for the reinstatement to really become withdrawal normal. I still feel so many s/s. They are changing and I feel stuff daily. Physical and Neuro emotion. I document all of it and rate it. The fear is there. Somehow I need to not be so frightened by all of this. I believe it will stabilize, it is just when??? You are so right when you say it is so slow. But, I am holding because I know I am not in WDnormal. Too much back and forth yet. Not that steady state you referred to earlier. I believe it will take a good bit of time because I did RI very small and I think I have quite a bit of adjusting that needs to continue. I think it could take several more months. I really need to know that this emotion , intense Neuro emotion can be expected. I am hoping it will level out more as I wait for steady. As the other physical s/s steady out also.

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Hi mods, I need some helpful thoughts and advice. I am now 4 mos. into my RI. No changes in dose have been made. I am just starting to experience better Windows and some less intense waves. Not good and steady yet. What I am now experiencing is trouble falling to sleep and waking early. Up until now, for the past 4 mos. I have been sleeping 7-8 hours per night. Now seeing 5 maybe 6. What is going on??? I have followed all of the tips for sleep except I do not tolerate mag citrate has opposite effect on me and mag glycinate too strong, even low dose makes me very dizzy. Very sensitive Neurology. I have not added any supplements as I do not tolerate them. Vit C 2500 mg day broken up in three doses but have been on for months now. Nothing new. What is causing the change now?? Just not sure what to think???

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