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Taking multiple psych drugs? Which drug to taper first?

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#73 wantmyhubbyback



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Posted 12 April 2016 - 01:23 PM


I am just wondering in general, do very many people do micro-tapers of all their drugs at the same time (let's say 2% of everything as an example)?  This seems like a bold move, and scary, but in some ways it makes sense to me. After all the drugs have been working together (in a good or bad way) for a very long time with me.  However, I have not read about anyone but Rhiannon doing this.  I applaud Rhiannon's courage and steadfastness, but I just don't read about anyone else doing it.   So the real question is...micro-tapering multiple drugs at the same slow, slow rate...good or bad idea?

Hi Saving Grace,


I am micro tapering two drugs at the same time though I originally just was tapering one.  I tapered my first drug Remeron from January - July and then started tapering my second drug Lamictal at the same time.   I did it after careful consideration and I also read Rhiannon's experience.  I am comfortable with the choice I made and I continually pay attention to my body's reaction.  I did make one error about a month ago but other than that, I feel good about the experience.  


I haven't avoided wd symptoms but I had them while tapering only one drug.  I also support my body with weekly acupuncture treatments. 


s-grace, alto can provide more info on this but i think the basic approach is to taper one at a time, starting with the most activating (unless it's a benzo) moving down to the most sedating. the reason for this is 1) if you taper more than one drug at a time, and have a W/D reaction, you won't know which drug to reinstate; and 2) if you remove the sedating drugs first, you're more likely to have issues with anxiety, insomnia, etc.  alto has made the point that rhiannon had years of experience with her symptoms and the ability to know with some certainty about what to do if she had a w/d reaction.


one alternative may be to "stair-step" -- that is, reduce drugs in series.  my hubby is stair-stepping down zyprexa and paxil now, with a minimal one-month waiting period after each reduction.  so far it's working ok. :)

diagnosed with MDD/GAD nov 2013, 6 months following CMV complications post-kidney transplant

lst zyprexa taper 12 months; /increased paxil to 30 mg; crash nov 2014 w/ suicidal ideation & 10day hospitalization

2nd zyprexa taper 6 months; crash after 6 weeks; reinstated zyprexa 15mg in 6/15 (both tapers worked well to the 2.5mg dose)

3rd zyprexa taper in progress ... 17mg 3 mos;  15mg 1 mo; 10mg 3 mos, 5 mg 3 mos. 2.5mg caused some decompensating, so back to 3mg and now doing the 10% redux

mirtazapine 30 mg 45mg

ativan .5mg 1x/day, occasionally .5 addl  if needed for sleep 3x/day n now 1x/day

paxil 20 mg 1x/day 

gabapentin 1200 - 1800 mg 2 -3 x/day

immunosuppressive drugs for kidney transplant: sirolimus, mycophenalate, prednisone, levothyroxin and a whole handful of others


#74 savinggrace


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Posted 13 April 2016 - 08:31 PM

thanks for both of your responses.  Yes, I have looked at this situation from both points of view.  At this point, it would be very difficult to discern what is causing anything, because I pretty much feel terrible all the time.  I know tapering multiple drugs would cause the "what is causing this" cycle, but I just can't help but wonder if they have all been working in tandem, does it upset the homeostasis more by changing the ratio of chemicals and their interaction with each other.


My gut says don't do it, though I am constantly trying to find another approach so I can keep making some sort of progress.  Does stair-stepping mean cutting one drug, then holding on that one, and cutting another, and then continuing the cycle?  That is sort of the plan I have right now...I believe it is what JanCarol suggested I do last week as well.  Since I am, albeit, very slowly cutting trileptal, (and finally feel more stable!), I am going to continue for a while, and then when I sense my brain needs a rest, I am going to try and cut remeron, something I have not tried to do yet.


Again, thank you both for sharing.



amitriptyline from 1980-2002, along wi/ intermittent use of benzos.  Klonopin 1-2 mg., ambien 10--20, mg, remeron 4 mg. and trileptal 300 mg 2002-2010.  Dropped ambien in 2011 w/ updose of klonopin and then crossed over to valium 17.5 mg.  Micro-tapering valium from 2011-2015.  Had to hold so started tapering trileptal.  cut 75 mg. in the last year and holding at 12.84 valium, 4 remeron and 219 trileptal. Began holding on all drugs May 30 2016 - ?

#75 Hibari


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Posted 14 April 2016 - 05:55 AM

Hi Grace,


Always good to go with your gut when making decisions on your health.


Just wanted to share that if you haven't cut your Remeron before, my experience is that it has a delayed wd response.  Meaning for me, I make a cut, feel the physical symptoms and then usually a 1 week to 2 weeks later the emotional symptoms hit.  That may not be your experience but it is a common reaction from what I have read.



September 2013-April 2014: After the death of my mom in July 2012.-became very depressed in September of 2013. Given a series of antidepressants very quickly from about 4 different psychiatrists in a 6 month period. Each one was from 1 day to 10 days at the most. My body could not handle it-I had Zoloft 6 days, Lexapro-1 day, Nortriptyline-10 days, Liquid Prozac, 1 week, Cymbalta 1 week.

December 2013-September 2014: Put on Xanax after a reaction to the Lexapro, averaging .50-1mg per day. Switched to Clonazepam-midway averaging about 0.25-0.50 daily.

June 2014: Jan/Feb 2015: Put on 7.5 Remeron titrate up to 41.25mgs

September 2014-July 2015: Put on 25mgs of Lamictal titrate up to 200mgs daily. Also stopped the Clonzepam- never felt the wd I had experienced when I tried to stop it before (knowing nothing about withdrawal) because the Lamictal calmed me down.


Currently: I tarted tapering Remeron from January 2015-April 2017-2 years, 3 months.  Started tapering Lamictal July 2015.  Tapered both medications together till I got to the lower doses of Remeron.   Main wd symptoms-sweating, nausea, headaches, deep crying, anxiety.

12/21/16 Remeron 1.6 Lamictal 22.50 mgs 1/19/17 Remeron 1.2mgs, Lamictal 22.50mg 2/12/17 Remeron 1.2 Lamictal 21.25 mgs 3/4/17 Remeron 0.85 Lamictal 21.25 3/14 Remeron 0.85 Lamictal 20mgs 3/22 Remeron 0.45 Lamictal 20mg 3/25 Remeron 0.45 Lamictal 18.75mgs 3/30 Remeron 0.025 4/7 Lamictal 18.75mgs Remeron 0.025 5/19/17 Lamictal 17.50


4/7/2017 Remeron Free stopped at 0.025mgs


Additional Support: Acupuncture with Reflexology, Alanon, L-Theanine for anxiety as needed, Estradial patch 0.025, Bio-indentical Progesterone cream 150-200 Armour Thyroid 90mgs.

#76 Alia02



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Posted 15 April 2016 - 02:47 PM

Hi a question for Altostrata or anyone else who may know. Im interested in the accelerating effects of A/D. Im my limited knowledge, I thought that it was mainly the SSRI's that were accelerating and the older tri-cyclics that were sedating.. that is what I was told? But my A/D seems to be a mixture of both and so its hard to know which to decrease next...my clomipraine (AD) or Seroquel. My hunch is to alternate from now on until I find the sedating effect of Seroquel is not holding...and then keep tapering the A/D. The thing I find difficult is that there is so little information I understand out there about my A/D. It makes me really sleepy, but then I wake bolt upright for a few hours a night. So thats why seroquel was added. Thanks

Chronic severe nerve pain and depression since 1984 (due to a motor vehicle accident and spinal injuries)  Due to long tern pain was on Morphine, Neurontin, Codeine, Valium . Off these meds altho occasional codeine.  Since 2002 Serequel for Insomnia. 25mg.  15 yrs on Clomipramine/tri-cyclic a/d.  Aug 2015. 100mg cut to 95mg. Late aug 95-90mg. Sept 1st, 90mg to 85mg. Sept 14.85mg to 80mg. October 1st , 80 to 75mg. Oct 15; 75 to 70.  Nov 1st ; 70mg-65mg.  Nov14: 65 to 60mg. 60mg. December ..break. Jan2016. 60mg to 55mg. Symptoms began: very sleepy, achy, light headed, dizzy, increased pain, numb, depressed..  Jan 30/ 55 to 50mg. Symptoms/ extreme tiredness. blurry vision and inaccurate vision, painful and itchy eyes, depression, insomnia, flu like symptoms. achy/ sweating/ relationship issues. work issues. Feb 10th. Back up to 55mg. Withdrawl symptoms subsided. March 10: 55 to 50mg. withdrawl ok. April 12 Seroquel 21mg May 12 Seroquel 17mg. Nov severe depression went up to 75mg Anti dep.  Jan 2017, diagnosed with Bi Polar 2 and prescribed 60mg Epilim. Instant relief. March Doc suggested slow decrease of anti dep so from 75 to 70, March 17, 2017.





#77 elbee


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Posted 15 April 2016 - 04:43 PM

Lots of great info here, thanks for the thread. I'm still a bit unclear on how remeron / mirtazapine fits into the recommended scheme of things. My understanding is that it's a "tetracyclic" and I don't see that "class" of drug mentioned in the opening post? I think I've seen recommendations that it should be reduced first, and recommendations that it should be reduced AFTER the AD (and presumably before the benzo. I'm going to post this on my intro thread, but I thought I would bring up the question here generally.

1990 (age 20, in college) - First major panic attacks (diagnosis, PD, GAD, Depression). Prescribed 100 mg sertraline, 2.5 mg lorazepam. Tried to reduce meds several times but essentially took these meds for about 25 years.
Summer of 2014 - Quit drinking alcohol and 3.5 month taper off all meds under doc supervision. October 2014 - Return of severe panic attacks, with 8-month "SSRI/Benzo chase" to try and stabilize. June 2015 - Found a drug "reinstatement" (more drugs than I had ever been on) that stopped the panic attacks, but was left with severe anxiety, depression, and numerous side effects: 150 mg sertraline (Z=Zoloft), 15 mg mirtazapine (R=Remeron), 2 mg clonazepam (K=Klonopin)

-- Begin new taper -- 12/11/16: Z=100 mg, R=6 mg, K=1 mg, 11/13/16: Z=100 mg, R=7.5 mg, K=1 mg, Z=100 mg, R=7.5 mg, K=1.5 mg, 9/1/16: Z=112.5 mg, R=7.5 mg, K=1.5 mg, 7/27/16: Z=125 mg, R=7.5 mg, K=1.5 mg, 5/1/16: Z=135 mg, R=7.5 mg, K=1.5 mg, 4/10/16: Z=150 mg, R=7.5 mg, K=1.5 mg, 3/1/16: Z=150 mg, R=7.5 mg, K=2.0 mg

My introduction thread.

#78 Altostrata



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Posted 16 April 2016 - 05:48 PM

Because many people take mirtazapine for sleep, often because the antidepressant they're taking keeps them awake, we suggest going off the most activating drug first, which would be the antidepressant. Theoreticallly, mirtazapine may help maintain sleep during the tapering process -- sleeplessness is common in withdrawal.

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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#79 Fresh


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Posted 21 April 2016 - 09:51 PM

ADMIN NOTE This topic is a general discussion about how to decide which drug to taper first. For case-by-case consideration of what YOU should do, please put your questions in an Introductions topic.
1987-1997 pertofran , prothiaden , Prozac 1997-2002 Zoloft 2002-2004 effexor 2004-2010 Lexapro 40mg
2010-2012Cymbalta 120mg
Sept. 2012 -decreased 90mg in 6months. Care taken over by Dr Lucire in March 2013 , decreased last 30mg at 2mg per week over 3 months. July 21 , 2013- last dose of Cymbalta
Protracted withdrawal syndrome kicked in badly Jan.2014 Unrelenting akathisia until May 2014. Voluntary hosp. admission. Cocktail of Seroquel, Ativan and mirtazapine and I was well enough to go home after 14 days. Stopped all hosp. meds in next few months.
July 2014 felt v.depressed - couldn't stop crying. Started pristiq 50mg. Felt improvement within days and continued to improve, so stayed on 50mg for 8 months.
Began taper 28 Feb. 2015. Pristiq 50mg down to 45mg. Had one month of w/d symptoms. Started CES therapy in March. No w/d symptoms down to 30mg.
October 2015 , taking 25mg Pristiq. Capsules compounded with slow-release additive.
March 2016 , 21mg

#80 JJ33



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Posted 15 October 2016 - 10:03 AM

Is Abilify considered an "accelerator" or a "brake"?  I'm currently withdrawing Abilify but based on the suggestion from Shep wonder if I should switch over to the Lexapro instead.

2.5 mg/Lexapro and 2.5 mg/Abilify a day for past seven years.
September 2016 - down to 2 mg/Abilify a day.
October 2016 - 1 mg/Abilify a day, took a few months then stabilized.
February 2017 - .75 mg/Abilify a day.
April 2017 - too fast, back up to 1 mg/Abilify a day.
May 2017 - about .9 mg/Abilify.

#81 Altostrata



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Posted 15 October 2016 - 10:27 AM

JJ, Abilify is generally a "brake." Lexapro is not a good bridge off Abilify. It sounds like that question belongs in your Introductions topic, as a continuation of a prior conversation with Shep.

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.