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The slowness of slow tapers (micro-taper)


Rhiannon

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I wish I had an answer, but I have wondered the same thing. One reason I decided to discontinue amitriptyline last year is the evidence that anticholinergic drugs are linked to dementia (ami has strong anticholinergic activity). I began with a too-fast taper and bad WD effects; now on a slow taper that will last about two more years at this rate. Will that continued exposure increase my risk of dementia? I have no way to know. The good news is that my current dosage is quite small, 20% of the smallest prescription dosage, which I assume reduces the anticholinergic activity and therefore the risk.

Amitriptyline: prescribed 10 mg/day in mid-August 2022

  • Began fairly quick taper 18 October 2022 to 3 mg by 9 November (no withdrawal symptoms)
  • Reinstated at 10 mg on 9 November leading to some serious sleep disturbance
    • 10–17 November, tried 8 or 9 mg
    • 18 November, 10 mg
    • 19–22 November, 3.5 mg after advice to drop back to taper level
    • 23 November – 14 Dec., 3 mg
    • 15–22 Dec., 2.7 mg
    • 23 Dec. 2022 to 3/15/2023, ranged from 2.5 mg up to 3 mg w/partial reinstatement after bad crash provoked by CBD/THC gummy, then slowly back down to 2.5 with long hold in March
    • from 15 March 2023, continued slow taper (Brassmonkey slide, 2.5% week + 2 week hold every 4 weeks) to 1.2 mg as of 1/1/24. Increased tapering speed to 20% in 6 weeks, probably bad idea.

Other medications: albuterol inhaler as needed, acetaminophen as needed

Supplements: daily multivitamin, magnesium glycinate 400 mg/day PRN, probiotics
Caffeine: Max 1 cup coffee/day or 2 cups of tea

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On 6/11/2023 at 5:22 PM, RobertZ said:

I was wondering if there is such a thing as a too slow taper. By that a mean a situation where the total duration of exposure to a drug from a very slow taper carries health risks that are worse than the withdrawal effects from a faster taper.

 

For example, when coming off an antipsychotic too fast, you might get a movement disorder due to "dopamine supersensitivity". But the same (or worse) might happen with long-term cumulative exposure to an antipsychotic (even at small doses) -- you might get tardive dyskinesia, which may be permanent and disabling, making it potentially worse than the consequences of a rushed taper.

 

This seems to be more relevant for antipsychotics, which are notorious for producing movement disorders, possibly less so for antidepressants. I'm curious what are people's thoughts/experiences on that.

I  think this is an assessment that each person has to do for themselves - what risks are they willing to take - coming off of an antipsychotic too fast can cause psychosis (even in those who did not have them before) and can initiate a further cascade of prescriptions. The withdrawal itself can be debilitating for years. 

 

On the other hand, staying on them also has its risks as you mentioned including risks of serious other health issues. 


Some cases are clearer - if someone is having a serotonin syndrome their life is at risk and withdrawal or no withdrawal symptoms we would tell them to stop the drugs immediately. Other cases are not so clear cut and the decision is deeply personal - it should be made by the person bearing the consequences. 


OMW

"Nothing so small as a moment is insurmountable, and moments are all that we have. You have survived every trial and tribulation that life has thrown at you up until this very instant. When future troubles come—and they will come—a version of you will be born into that moment that can conquer them, too." - Kevin Koenig 

 

I am not a doctor and this should not be considered medical advice. You can use the information and recommendations provided in whatever way you want and all decisions on your treatment are yours. 

 

In the next few weeks I do not have a lot of capacity to respond to questions. If you need a quick answer pls tag or ask other moderators who may want to be tagged. 

 

Aug  2000 - July 2003 (ct, 4-6 wk wd) , citalopram 20 mg,  xanax prn, wellbutrin for a few months, trazodone prn 

Dec 2004 - July 2018 citalopram 20 mg, xanax prn (rarely used)

Aug 2018 - citalopram 40 mg (self titrated up)

September 2018 - January 2019 tapered citalopram - 40/30/20/10/5 no issues until a week after reaching 0

Feb 2019 0.25 xanax - 0.5/day (3 weeks) over to klonopin 0.25 once a day to manage severe wd

March 6, reinstated citalopram 2.5 mg (liquid), klonopin 0.25 mg for sleep 2-3 times a week

Apr 1st citalopram 2.0 mg (liquid), klonopin 0.25 once a week (off by 4/14/19- no tapering)

citalopram (liquid) 4/14/19 -1.8 mg, 5/8/19 - 1.6 mg,  7/27/19 -1.5 mg,  8/15/19 - 1.35, 2/21/21 - 1.1 (smaller drops in between), 6/20/21 - 1.03 mg, 8/7/21- 1.025, 8/11/21 - 1.02, 8/15/21 - 1.015, 9/3/21 - 0.925 (fingers crossed!), 10/8/21 - 0.9, 10/18/21 - 0.875, 12/31/21 - 0.85, 1/7/22 - 0.825, 1/14/22 - 0.8, 1/22/22 - 0.785, 8/18/22 - 0.59, 12/15/2022 - 0.48, 2/15/22 - 0.43, 25/07/23 - 0.25 (mistake), 6/08/23 - 0.33mg

 

Supplements: magnesium citrate and bi-glycinate

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Can I ask a question here? I’ve been tapering Prozac liquid from a compounding pharmacy and am at 5.45mgs. The last script I received was about two months ago and I’m either dealing with fear the script was screwed up or it was. I have no way of telling if it’s not correct and it does create a bit of distress wondering about it. I only have so much control on this. The pharmacy said it was the same manufacturer. Would it be better to just switch to the manufactured fluoxetine and just adjust it as it need it rather than having the compounding pharmacy keep changing the dose for me? I am going through some tough times and I’m not sure if it’s from being at a low dose or something else. When I do taper it’s 1-2%. Any help would be so appreciated thank you 

1993 started 20mg Prozac.

2008 switched to 10mg of lexapro.

2015 added 50mg of Wellbutrin. Between 2015 and 2020 raised and lowered dosage of both. 2021 moved to Zoloft for one month then back to lexapro for one month. Then switched to 60mg cymbalta for four months. Then Basically cold turkeyed off cymbalta in two weeks using Prozac as a crossover med to reduce withdrawals. Not good. Then had Nortriptylene added to Prozac. Was on 20mg Prozac and 50mg of Nortriptylene for four months. Then did a four month ween off Nortriptylene. To date have been off cymbalta for approximately 11 months and Nortriptylene 7 weeks.  Presently taking 12.5 mg Prozac. Also taking 10 mg of bystolic for BLood Pressure. I’m not sure how the Prozac makes me feel. It does nothing to make me feel not sad and anxious at times. I finally figured out the meds are not what I need. What I need is to get off the 12.5mg of Prozac and continue to work on my stuff. Any help is deeply appreciated thank you. Reduced from 12.5 to 10 then from 10 to 7.5. Too much of a drop. Bought a scale and went to 9. Stabilized and went to 8.2 oct 1, 2022. Just got hit with wicked low mood, high anxiety, fatigue, chills. The anxiety is high in the AM and  lessons throughout the day. Hoping to stabilize soon 

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On 7/1/2023 at 3:09 AM, Mezzer said:

Can I ask a question here? I’ve been tapering Prozac liquid from a compounding pharmacy and am at 5.45mgs. The last script I received was about two months ago and I’m either dealing with fear the script was screwed up or it was. I have no way of telling if it’s not correct and it does create a bit of distress wondering about it. I only have so much control on this. The pharmacy said it was the same manufacturer. Would it be better to just switch to the manufactured fluoxetine and just adjust it as it need it rather than having the compounding pharmacy keep changing the dose for me? I am going through some tough times and I’m not sure if it’s from being at a low dose or something else. When I do taper it’s 1-2%. Any help would be so appreciated thank you 

Please see this link on how to make your own tapering liquid using tablets. 

You will need to determine the level of solubility of Prozac tablets. For instance, if Prozac is soluble in water, then you can use water to make your own liquid. If it is soluble in saline, you can make your own isotonic saline and dissolve a tablet in saline. I do this with Cipralex (active ingredient Excitalopram). 

 

This thread mentions that Prozac tablets are soluble in water. You will need to be sure that you are not taking a slow-release tablet. 

Making your own liquid from tablets will allow you much greater control over the dosage and then you can be sure every time that you are taking the correct dosage. You could perhaps also adjust the dosage yourself using the manufactured liquid, with a little math. There is a thread on here that deals with that. Hope this helps!

43yo woman. Cipralex/Lexapro (10mg active ingredient Escitalopram) treatment started March 2007 (28yo at the time). Two unsuccessful tapers (2008 and 2013). Two psychiatric hospital stays (2007 and 2014). Other psychiatric drugs were prescribed and taken from Apr 2014 until June 2016. Tapered off all of the below by June 2016 and from then on have been on Cipralex/Lexapro only.

List of drugs that I had tapered off of so far:

Lamictal (Lamotrigine), Esperide (Sulperide), Dormonoct (Loprazolam), Rivotril (Clonazepam, Klonopin), Prozac (Fluoxetine), Cipramil (Citalopram, Celexa), Stilnox (Zolpidem), Urbanol (Clobazam), Olexar (Olanzapine) and Seroquel (Quetiapine). 

Taking Cipralex (Lexapro) only since June 2016.

Currently on extended Cipralex (Lexapro) taper since Nov 2016.

Started compounded liquid suspension on 01Nov 2022 (1.3mgai/2.5ml). Had problems with flavourant in compounded liquid. June 23: Started to make own liquid from commercial saline then had eye blinking. July 23: Making own liquid using home-made isotonic saline and adding this liquid to gelatine capsules so the liquid will not irritate my esophagus.

Okt23: Current dosage 1.15mg Escitalopram. Jan 2024: 1.12mg Escitalopram. 

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Wanted to mention that it may also be that you are tapering too much at a time. My tapers are typically less than 1% at a time. You need to find a taper ratio that will result in not more than 2 - 3 days' of symptoms.

43yo woman. Cipralex/Lexapro (10mg active ingredient Escitalopram) treatment started March 2007 (28yo at the time). Two unsuccessful tapers (2008 and 2013). Two psychiatric hospital stays (2007 and 2014). Other psychiatric drugs were prescribed and taken from Apr 2014 until June 2016. Tapered off all of the below by June 2016 and from then on have been on Cipralex/Lexapro only.

List of drugs that I had tapered off of so far:

Lamictal (Lamotrigine), Esperide (Sulperide), Dormonoct (Loprazolam), Rivotril (Clonazepam, Klonopin), Prozac (Fluoxetine), Cipramil (Citalopram, Celexa), Stilnox (Zolpidem), Urbanol (Clobazam), Olexar (Olanzapine) and Seroquel (Quetiapine). 

Taking Cipralex (Lexapro) only since June 2016.

Currently on extended Cipralex (Lexapro) taper since Nov 2016.

Started compounded liquid suspension on 01Nov 2022 (1.3mgai/2.5ml). Had problems with flavourant in compounded liquid. June 23: Started to make own liquid from commercial saline then had eye blinking. July 23: Making own liquid using home-made isotonic saline and adding this liquid to gelatine capsules so the liquid will not irritate my esophagus.

Okt23: Current dosage 1.15mg Escitalopram. Jan 2024: 1.12mg Escitalopram. 

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@Lenaf thank you. I did make small decreases, just didn’t wait long enough in between. I’m learning slowly and sometimes painfully 

1993 started 20mg Prozac.

2008 switched to 10mg of lexapro.

2015 added 50mg of Wellbutrin. Between 2015 and 2020 raised and lowered dosage of both. 2021 moved to Zoloft for one month then back to lexapro for one month. Then switched to 60mg cymbalta for four months. Then Basically cold turkeyed off cymbalta in two weeks using Prozac as a crossover med to reduce withdrawals. Not good. Then had Nortriptylene added to Prozac. Was on 20mg Prozac and 50mg of Nortriptylene for four months. Then did a four month ween off Nortriptylene. To date have been off cymbalta for approximately 11 months and Nortriptylene 7 weeks.  Presently taking 12.5 mg Prozac. Also taking 10 mg of bystolic for BLood Pressure. I’m not sure how the Prozac makes me feel. It does nothing to make me feel not sad and anxious at times. I finally figured out the meds are not what I need. What I need is to get off the 12.5mg of Prozac and continue to work on my stuff. Any help is deeply appreciated thank you. Reduced from 12.5 to 10 then from 10 to 7.5. Too much of a drop. Bought a scale and went to 9. Stabilized and went to 8.2 oct 1, 2022. Just got hit with wicked low mood, high anxiety, fatigue, chills. The anxiety is high in the AM and  lessons throughout the day. Hoping to stabilize soon 

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