Micro-taper instead of 10% or 5% decreases

[Rossho]

On 5/4/2016 at 1:28 AM, Altostrata said:

You can dilute the liquid drug more so you can measure small amounts with the same syringe.

I will be diluting my liquid risperdal with water in that way.

[Sebas]

On 4/10/2013 at 11:08 AM, Rhiannon said:

I would add, start with smaller cuts at first, too.

 

And keep a journal of your dosages and your symptoms (ranking them on a numerical scale, like 1 to 5).

 

I know we are all so impatient to get off these drugs--I started my tapers WAY too fast, and paid for it!--it's hard to take it slow at the start. But it is SO worth it, because you can learn your own body's patterns of withdrawal and recovery, and you can adjust your taper to your own needs.

 

Once you have a sense of how your body's going to react to cuts, and how the withdrawal process unfolds for you over time, and how long you need to hold before you can cut again, you can adjust up the speed of your taper until you find the pace that gives you the optimal balance between tapering progress and minimizing withdrawal symptoms. And once you learn how your body reacts to tapering you can fine-tune your taper according to the demands of your life.

 

For example, if you have a special occasion coming up that you want to be feeling good for, you will know how long you need to hold your taper beforehand. Or, if you know you have a nice low-key stress-free time coming up and you want to push your taper a bit harder, you know how much you can get away with and how much lead time you can expect before the symptoms ramp up.

 

It's really worth taking the time to get to know your body's responses right up front, if you can summon the patience. Way better than doing what I did at first, pushing it too hard and then crashing and burning. Big ouch.

 

Great contribution 😉

[Sebas]

I think one of the reasons some people have to go for micro-tapering, besides personal circumstances and CNS, has to be the drug period.

The longer the nerve system is "put to sleap" by a drug, the slower a taper might be.

The 5-10% rule must, in my opinion, be seen as a general principle and is also very dependent of the phase of taper one is currently in.

And also very related to circumstances in life (work, removal, stress level, holiday, relationship etc.).

Going from 20 mg to 18 mg was "no big deal" but nowadays at 11,4 mg i can hardly imagine going down with 10%.

So i'm happy to have read about the #MT (micro tapering).

Just do what feels right for you.

 

Thanks @Altostrata and others for creating and feeding the topic.

 

[Altostrata]

We haven't seen a need for a micro-taper to be drug-specific. It's very individual.

 

You're welcome, Sebas.

[Sebas]

@Altostrata sorry i meant the drug time (I thought period was the right word)

[Altostrata]

I think you mean half-life. We haven't seen a connection between half-life and a need for micro-tapering.

[Sebas]

I meant how long has someone been using the drug

[Altostrata]

On 11/13/2018 at 8:27 AM, Sebas said:

I meant how long has someone been using the drug

 

Maybe, but a lot of our long-time drug users can tolerate a 10% decrease per month. I believe the determining factor is nervous system sensitivity, not any drug characteristic.

[Superwoman]

How often and for how long does one need to hold for when doing a micro-taper?

[ChessieCat]

Have you read the first few posts of this topic?

 

Have you considered the Brass Monkey Slide.  You can reduce the % rate to whatever you like and hold whenever you feel that you need to.

[Onmyway]

Recently I have been doing some micro-tapering - this is even slower than the Brassmonkey slide method - I went at 0.5% every week to 10 days. The issue was that instead of not feeling much, I was feeling quite intense symptoms and they would last for a week or two at which point I would drop again. These symptoms were not very different from the larger drops that I had made though the physical issues were lacking, it was mostly psychological rumination/OCD-like anxiety/insomnia/muscle tightness/agitation. I did not have nausea and dizziness. 

 

I am worried that at this rate of tapering I will just end up suffering much longer than if I do slightly larger drops (still under 10% a month). 

 

This Horowitz and Taylor paper advises a mini-taper rather than a micro-taper

 

"Some practical consequences of these principles The model proposed also resolves a quandary often raised by patients and treating physicians: whether to ‘micro-taper’ or ‘mini-taper’. ‘Micro-tapering’ involves miniscule decrements in SSRI medication every day or week. ‘Mini-tapering’ involves step-wise larger decrements, with longer intervals in between decrements (generally, weeks). ‘Minitapering’ appears more sensible than ‘micro-tapering’ (although both are linear methods). 10 Withdrawal symptoms are reported to last for several weeks (or longer) after medication discontinuation in a significant proportion of patients 9,13. Given this pattern, ‘microtapering’ presents the possibility of cumulative withdrawal effects superimposing upon one another. This would make it difficult to establish which reduction (or set of reductions) were responsible for symptoms experienced. It therefore seems prudent to decrease the dose of medication, allow a significant period of time to elapse while withdrawal effects resolve, before commencing the next decrement."

 

Horowitz_Taylor_A_method_of_tapering_SSRI_treatment_to_mitigate_withdrawal_symptoms.pdf (kcl.ac.uk)

(this is an open access version of the Lancet paper, I think)

 

I wonder if anyone has an opinion on this? 

@brassmonkey how did you choose to do your micro-taper and did you experiment with others? 

 

[brassmonkey]

The art of tapering ADs is ever changing as we learn new information about how they actually work and gain more experience in tapering . When I started my taper just over ten years ago the 10% every four weeks rule was fairly new and just being tried out. What I was able to find out made sense to me, but I didn't like the fact that it hit a person with a heavy symptom load a day or two later.  One of my prime concerns was to remain as functional as possible being the sole provider for my family. Thinking it through I came up with the idea of splitting up the reductions to help reduce the shock. Then added on a hold to let things settle down before doing it again.

 

I was tapering out of a very strong tachyphylaxis, so it was quite hard to gage things at first. You have to overcome the tolerance before the reductions make any headway symptom wise. But I was not hit with a strong symptom load with each reduction, which is what I was after. This method worked well for me so I used it for my entire taper. I did have to modify it a bit for the Endgame because of the limitations of my scales. 

 

The tapering style a person uses is up to their situation. It is always best to start very conservatively and modify as one goes. However, you need to keep the limits in mind. We have proved time and again that 10% every four weeks is about as fast as is safe to taper. Any attempt to go faster or larger invariably ends in a crash. This forces the person to stop tapering, adjust their dose, and stabilize for what could be many months before continuing to taper.

 

I find that in most cases microtapers are tedious and unnecessary. There are individuals that are overly sensitive to the reductions and need to do microtapers, but they have to find out by experimentation if that is the case. I have found over the years that a Brassmonkey Slide or one that has been modified to use smaller reductions is the most effective way to reduce. We have a large and growing membership that are using it successfully.

[Nicjk]

Is it possible to do a micro taper using a scale and weighing a solid pill? I recently bought a $600 analytical scale that is very accurate and I'm hoping to do a micro taper off 5mg of Olanzapine later this year

[PeerCBH]

On 8/31/2012 at 8:22 AM, Altostrata said:

ADMIN NOTE Also see

 

Why taper by 10% of my dosage?

 

The slowness of slow tapers

 

The Brassmonkey Slide Method of Micro-tapering

---

 

A micro-taper is a way to go off psychiatric medications in a very gradual way that doesn't depend on the calculation of 10% decreases.

 

Often, micro-tapering isn't any faster in total than a 10% or 5% reduction, but for people whose nervous systems are exceptionally sensitive, it may be more tolerable than the relatively larger reductions.

 

To do this, you need to taking a liquid medication or one that comes in capsules filled with beads, such as Effexor XR or Cymbalta. The micro-taper method is particularly helpful in going off benzodiazepines, where people are often sensitive to minute changes in dosage.

 

The idea is you might be able to make smaller decreases more often. Micro-tapering does NOT mean making a reduction every day -- don't go faster than your nervous system allows!

 

People who have tried a 10% or 5% reduction and already understand their withdrawal symptom pattern and nervous system tolerance for dosage changes are in a good position to try this. They may already have a feel for the amount of the micro-reduction, for example, 1 bead or .5mg.

 

A very sensitive person might want to make reductions of .01mg as often as they can without getting withdrawal symptoms.

 

Example of how to do a micro-taper

• Decide on the amount of your micro-taper, for example, 1 bead of Cymbalta.

   

  If you have had problems with a 10% taper, the amount of your micro-taper will be much smaller than 10%. For example, if you find you can't reduce 10% from 25mg -- 2.5mg -- without withdrawal symptoms, your micro-taper would be a fraction of 2.5mg, such as .5mg.

• Reduce your dose by the micro amount. Take this dose for a week.
• If no withdrawal symptoms, you may be able to reduce by the micro amount more often, such as every 4 days. For most drugs, it takes about 4 days for a change to fully register. If you go faster than that, you might exceed your tolerance for dosage reduction and not know it until it's too late.
• You may wish to hold on reduction ever so often, to allow your nervous system to rest and integrate at the reduced level of medication.
• This may work fine for a while, then you might find you feel the micro decrease. This is a sign to either 1) make the micro decrease even more micro, or 2) you need longer holds between drops.
• Keep a journal of your symptom pattern and dosage drops so you can see how the decreases are affecting you.
• As with any tapering schedule, if withdrawal symptoms appear, slow your tapering or hold on the current dosage until the nervous system stabilizes.

   

  According to our member Rhi, she controls her micro-taper by "paying close attention to my withdrawal symptoms and holding longer whenever they seem to be ramping up at all.

   

  This requires being VERY attentive to your symptoms and I also recommend keeping a chart of dose changes versus symptoms. But I find that it allows me to adjust my taper quickly and subtly as needed."

Liquid solutions are helpful for micro-tapers because they enable very gradual, controlled tapering. Many drugs are available in liquid solution form, or they can be made into a liquid by a compounding pharmacy. Some drugs, such as Prozac, can be made into a solution with water at home. Use the Search box at the upper right for tips about tapering specific medications.

 

See also:

Making a liquid from a tablet or capsules .

Using a digital scale to measure doses.

The Brassmonkey Slide Method of Micro-tapering

Alto, I'm curious as to how this applies to fluoxetine. For me it takes about 25 days for symptoms to appear. 

[Altostrata]

15 minutes ago, PeerCBH said:

People who have tried a 10% or 5% reduction and already understand their withdrawal symptom pattern and nervous system tolerance for dosage changes are in a good position to try this.

 

You'd have to assess how intense the withdrawal symptoms are and how long they last with a 10% taper. If they are mild and go away after a few days, you may wish to taper by 10% at 5- or 6-week intervals.

 

If they are more intense or last longer, you may wish to taper by less than 10% and see what your withdrawal symptom pattern is under that condition.

 

If your withdrawal symptoms take 25 days to appear no matter what your reduction, you probably will not want to taper faster than every 4 or 5 weeks.

[PeerCBH]

39 minutes ago, Altostrata said:

 

You'd have to assess how intense the withdrawal symptoms are and how long they last with a 10% taper. If they are mild and go away after a few days, you may wish to taper by 10% at 5- or 6-week intervals.

 

If they are more intense or last longer, you may wish to taper by less than 10% and see what your withdrawal symptom pattern is under that condition.

 

If your withdrawal symptoms take 25 days to appear no matter what your reduction, you probably will not want to taper faster than every 4 or 5 weeks.

Okay, for sure. Thank you. What is a "normal" percentage? Are there people who have to go as low as 2-3%?

 

How about reducing every week? With fluoxetine I won't see the results of the first week's reduction until I've already reduced two more times. If it's too much, I won't know until it's too late.

[Altostrata]

There's no "normal" percentage of taper, it's what's comfortable for each individual. Most people are comfortable with a 10% exponential reduction per month. For some, this is too fast.

[Sandra88]

How to micro taper a Pill that is film coated like Seroquel Immediate release?

Does anyone knows if cutting it will add more to the  withdraw symptoms?

[Altostrata]

FYI Dr. Horowitz made up the term "mini-tapering" -- he is referring to the steps in the Horowitz-Taylor hyperbolic tapering theory.

 

Micro-tapering involves reductions smaller than his method. Cumulatively over several weeks or a month (both he and we recommend this observation period) micro-tapering may result in a reduction as large or larger as any of his steps (often, the total monthly amount is smaller, since people who are very sensitive tend to use it). 

 

For example, a step in the Horowitz-Taylor hyperbolic method may be a 1.5mg reduction (resulting in a 10% reduction in receptor occupancy) with an observation period of 4 weeks. Over the 4 weeks, the nervous system is expected to gradually adapt to the reduction, with no or tolerable withdrawal symptoms (hopefully only in the first part of the observation period).

 

A micro-taper might be a 0.01mg reduction per day for 4 weeks, or 0.28mg for the entire month. It's a much smaller, gradual reduction in receptor occupancy. An extremely gradual reduction is sized to be comfortable with the chosen adaptation period, which could be 24 hours for daily reductions, or longer -- whatever the person has found to be comfortable.

 

Often, very sensitive people who have failed at 10% or 5% or less tapers find a microtaper more comfortable. You could say that if stepping down a stairs is a more comfortable and less risky way to leave a building than jumping from the roof,  taking a very gentle ramp down the stairs, maybe like the 3% incline of Frank Lloyd Wright's ramp for the Guggeheim museum, might enable a safe exit for for the mobility impaired. 

 

At the beginning of this topic, we recommend that people embark on a micro-taper only when they know their withdrawal symptom pattern, as they will have to watch out for those symptoms if they proceed with a frequent reduction.

 

Of course, some people will be daredevils and figure if a 0.01mg reduction per day is tolerable, they may as well try a larger reduction. But they're do the same with a self-guided exponential taper or hyperbolic taper as well. All we can do is inform people and warn them of pitfalls, we cannot prevent them from disregarding the cautions.

 

We have had many people here who have micro-tapered when all else failed and managed to minimize or go off their drugs.

[shurico]

On 4/24/2016 at 6:06 PM, Oneday77 said:

Hi!

I am doing a micro-taper of Cymbalta. I am taking off 1% ever month. This is what works for me. I don't care how long it will take. Every morning is a little victory when I empty beads from the capsule. I have played with the timing of my medication as well. If I take it around 7 am, I am good all day until 7 pm. Then I feel a little nauseous. At least it happens when I am done work and ready to slow down my day and Kids are in bed. I have been on Cymbalta for 10 years, I can handle another year or two. I am also seeing a psychologist and a naturopath to help me. The interesting thing is that even though I have lowered my dose, I don't feel worst emotionally than I did on the full dose. I feel the same, and some days I feel better. The Cymbalta was only preventing me from crying and feeling aware of my emotions. I now cry a little more and I seem morr able to see my emotions for what they are. They are not me. I still have a long way to go, but I feel more in control. This site has given me better information and support than any doctors or books could. Thanks!

Hi OneDay! how are you? have you been able to get off cymbalta? I am on 27.4mg and it is causing me extreme nausea everyday. Idk if its adverse reaction or withdrawal? i can barely make a 2% drop because it is giving me so many symptoms.....i don t know how much more I can handle this

[Sunflower414]

I am on 10mg of Paxil. I was going 3-4-% and have hit some big waves. I wanted to try micro tapering every week. What is a good amount to do for this? 

[Sebas]

@Sunflower414 you were doing okay. Big waves can be caused by lot of things not just the taper protocol. Keep taking small steps for example 9.8, 9.6, 9.4, 9.2 and adjust or take a longer hold whenever your body or CNS tells you its too much. No caffein, chocolate, processed foods, supplements or other medicine unless necessary. 

 

[Sunflower414]

Thanks for your advice @Sebas It is true a wave can be caused by other things and I easily forget that. Are you still tapering 0.1mg per week. How is that going?

[Sunflower414]

Is microtapering sometimes not a good idea? 
 

I was doing 2-4% cuts. I was hoping for less withdrawal symptoms so I did a .5% cut a few days ago and so far it feels exactly like a 4% drop. Should I continue trying the microtaper or just go back to the larger cuts if they feel the same?