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After Reinstating or Updosing, How Long To Stabilize?


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#73 Newbeginning

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Posted 24 September 2016 - 09:54 PM

Has anyone become unstable after a long (4 month) hold? How does reinstating work in that case? I was stable for months and holding because I was trying supplements. I got off all supplements 2 weeks ago, but there's been minimal improvement only. My next option is reinstating a bit.

 

I'm worried that if I reinstate after a long hold, I might destabilize my system and/or make future tapers harder.


  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivinganti...313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression

    March 27/2017: Anxiety improved; severe depression continues


#74 reachingforthestars

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Posted 24 September 2016 - 10:15 PM

I updosed after holding about a month from 4mg to 5mg and I had back reaction to it(akathisia, insomnia ect.). I also updosed from 2.6mg to 2.8mg after holding a week and had back reaction (akathisia). I never tried to hold for 4 days to stabilize and I think it is dangerous to try to hold if you get bad reaction. Also I think that there cannot be 4 days rule since different drugs have different half lives. I think that bad reaction means serotonin syndrome since the symptoms are so alike. Maybe receptors have become more sensitive and that's why even little updosing means big stimulation in the brain?


Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 


#75 Newbeginning

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Posted 25 September 2016 - 12:48 AM

On the first instance of updosing, perhaps it was too much of an increase? When you had been holding for a month, I assumed you were in withdrawal?
 
On the second updosing, you didn't increase a lot, but I wonder how you were before that? Looking at your signature, you've been going rather fast. If you've been having withdrawal and kept cutting, your reactions to updosing may just be the same withdrawal that you had before, which the reinstatement didn't help. Sometimes if we get very unstable, reinstating doesn't work or can make us worse.
 
In my case, I've updosed several times and it always helped me stabilize. However, I never had withdrawal without cutting. It's been 4 months on the same dose so I'm not sure how my body will react if I updose. I don't even understand why I'm having withdrawal after 4 months of being stable right after another updose. My last change was an updose, not a cut! And it was over 5 months ago. I've been stable for 3 months and the last month had issues.


  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivinganti...313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression

    March 27/2017: Anxiety improved; severe depression continues


#76 reachingforthestars

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Posted 25 September 2016 - 01:09 AM

I know the difference between Wd symptoms and bad reaction. It is very clear to me since I know my body and they are very different kind of symtoms. Also the bad reaction is immediate akathisia after 1 or 2 hours after the dose of SSRI. I never have had akahisia as WD symptom.

Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 


#77 Newbeginning

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Posted 25 September 2016 - 01:15 AM

I understand. It can also be a side effect of the med, which would show at higher doses. I'm not saying it was not a reaction to updosing. I just thought it could be other things too.
 
When that happened to you, I assume you decreased and the reaction resolved. But what about the withdrawal symptoms that you were trying to address with the updose? What happened to those symptoms when you updosed and then decreased again?
  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivinganti...313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression

    March 27/2017: Anxiety improved; severe depression continues


#78 reachingforthestars

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Posted 25 September 2016 - 01:37 AM

I didn't have much other WD symptoms than extreme muscle weakness. At one point I couldn't get out house because of the muscle weakness. Mentally I was very emotional and crying and laughing a lot and it felt good to feel again so much. There were some minor other physical symptoms but nothing bigger except that weakness. I was sleeping a lot like 14 hours a day and i was very relaxed, but due to weakness i wanted to try updosing...
 
Updosing made me extremely agitated added insomnia alkathisia and anhedonia and didn't help with muscle weakness at all. It helped when I reduced my dose to previous and akathisia lifted but anhedonia is still there and my sleep is still lighter that before updosing. 
 
Very very slowly muscle weakness has alleviated a lot and now i can walk 1 hour a day.

Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 


#79 Newbeginning

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Posted 25 September 2016 - 01:44 AM

I see. So for you updosing led to bad results and some of those bad symptoms have not resolved completely even months later. That scares me :(
 
Was the weakness there at all before you started tapering (and got worse when tapering)?
 
The times when I updosed I had unbearable symptoms like bad anxiety that lasted months, and the updosing helped. But right now the situation is more uncertain.
 
Thanks for sharing your experiences. I appreciate it :)
  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivinganti...313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression

    March 27/2017: Anxiety improved; severe depression continues


#80 reachingforthestars

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Posted 25 September 2016 - 02:15 AM

No, before tapering I was in very good shape physically, athletic swimming and jogging.

Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 


#81 brassmonkey

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Posted 25 September 2016 - 10:26 AM

Serotonin Syndrome is a very serious condition caused by toxic level of serotonin in the brain.  It is NOT caused by a small updose when a person is taking a minuscule dose. Because of the nature of the drugs WD symptoms, side effects and serotonin syndrome will have some things in common, but WD symptoms and side effects are not serotonin syndrome.

 

Half life is only one small factor in determining blood level steady state.  The 4 day rule takes into account half life, absorption rates, metabolic rates, dosing schedule, the aggregate experience of thousands of case histories and many other factors. After an increase in dosage it can take several weeks to many months to stabilize. During that time it is recommended that a person not change dose until they have stabilized. To do so increases the risk of further destabilization.  Also note that stabilization does not mean symptom free.  It means that the symptoms have evened out to a consistent level with no big swings either direction.


20 years on Paxil starting at 20mg and working up to 40mg. Sept 2011 started 10% every 6 weeks taper (2.5% every week for 4 weeks then hold for 2 additional weeks), currently at 7.9mg. Oct 2011 CTed 15oz vodka a night, to only drinking 2 beers most nights, totally sober Feb 2013.

Since I wrote this I have continued to decrease my dose by 10% every 6 weeks (2.5% every week for 4 weeks and then hold for an additional 2 weeks). I added in an extra 6 week hold when I hit 10mg to let things settle out even more. When I hit 3mg it became hard to split the drop into 4 parts so I switched to dropping 1mgpw (pill weight) every week for 3 weeks and then holding for another 3 weeks.  The 3 + 3 schedule turned out to be too harsh so I cut back to dropping 1mgpw every 4 weeks which is working better.

Current dose 0.000mg 04-15-2016

 

"It's also important not to become angry, no matter how difficult life is, because you can loose all hope if you can't laugh at yourself and at life in general."  Stephen Hawking


#82 Newbeginning

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Posted 25 September 2016 - 12:55 PM

Serotonin Syndrome is a very serious condition caused by toxic level of serotonin in the brain.  It is NOT caused by a small updose when a person is taking a minuscule dose. Because of the nature of the drugs WD symptoms, side effects and serotonin syndrome will have some things in common, but WD symptoms and side effects are not serotonin syndrome.

 

Half life is only one small factor in determining blood level steady state.  The 4 day rule takes into account half life, absorption rates, metabolic rates, dosing schedule, the aggregate experience of thousands of case histories and many other factors. After an increase in dosage it can take several weeks to many months to stabilize. During that time it is recommended that a person not change dose until they have stabilized. To do so increases the risk of further destabilization.  Also note that stabilization does not mean symptom free.  It means that the symptoms have evened out to a consistent level with no big swings either direction.

 

 

Brass,

 

If you were stable after a several month hold, can you still benefit from updosing, or is it a bad idea?


  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivinganti...313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression

    March 27/2017: Anxiety improved; severe depression continues


#83 brassmonkey

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Posted 25 September 2016 - 02:37 PM

If you're stable then why would you want to be updosing?

 

"My last change was an updose, not a cut! And it was over 5 months ago. I've been stable for 3 months and the last month had issues."

 

If your symptoms are starting to kick up after several months of stability, that would indicate the beginnings of a tolerance issue and the best thing to do would be starting a slow gentle taper. Up dosing would just add fuel to the tolerance issue.  It's counter intuitive but the best way out of tolerance is to decrease.


20 years on Paxil starting at 20mg and working up to 40mg. Sept 2011 started 10% every 6 weeks taper (2.5% every week for 4 weeks then hold for 2 additional weeks), currently at 7.9mg. Oct 2011 CTed 15oz vodka a night, to only drinking 2 beers most nights, totally sober Feb 2013.

Since I wrote this I have continued to decrease my dose by 10% every 6 weeks (2.5% every week for 4 weeks and then hold for an additional 2 weeks). I added in an extra 6 week hold when I hit 10mg to let things settle out even more. When I hit 3mg it became hard to split the drop into 4 parts so I switched to dropping 1mgpw (pill weight) every week for 3 weeks and then holding for another 3 weeks.  The 3 + 3 schedule turned out to be too harsh so I cut back to dropping 1mgpw every 4 weeks which is working better.

Current dose 0.000mg 04-15-2016

 

"It's also important not to become angry, no matter how difficult life is, because you can loose all hope if you can't laugh at yourself and at life in general."  Stephen Hawking


#84 Newbeginning

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Posted 25 September 2016 - 10:01 PM

If you're stable then why would you want to be updosing?

 

"My last change was an updose, not a cut! And it was over 5 months ago. I've been stable for 3 months and the last month had issues."

 

If your symptoms are starting to kick up after several months of stability, that would indicate the beginnings of a tolerance issue and the best thing to do would be starting a slow gentle taper. Up dosing would just add fuel to the tolerance issue.  It's counter intuitive but the best way out of tolerance is to decrease.

 

I thought about that, but some of the other moderators don't believe in "tolerance withdrawal". They believe if this is withdrawal, then cutting more will cause more instability.

 

If I don't stabilize within a week or two, I'll try cutting a little. If I get worse then will take it from there.

 

Thanks for the advise!


  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivinganti...313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression

    March 27/2017: Anxiety improved; severe depression continues


#85 reachingforthestars

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Posted 25 September 2016 - 10:16 PM

Serotonin Syndrome is a very serious condition caused by toxic level of serotonin in the brain.  It is NOT caused by a small updose when a person is taking a minuscule dose. Because of the nature of the drugs WD symptoms, side effects and serotonin syndrome will have some things in common, but WD symptoms and side effects are not serotonin syndrome.

 

Half life is only one small factor in determining blood level steady state.  The 4 day rule takes into account half life, absorption rates, metabolic rates, dosing schedule, the aggregate experience of thousands of case histories and many other factors. After an increase in dosage it can take several weeks to many months to stabilize. During that time it is recommended that a person not change dose until they have stabilized. To do so increases the risk of further destabilization.  Also note that stabilization does not mean symptom free.  It means that the symptoms have evened out to a consistent level with no big swings either direction.

 

"Extremely high levels of serotonin can cause a condition known as serotonin syndrome, with toxic and potentially fatal effects. In practice, such toxic levels are essentially impossible to reach through an overdose of a single antidepressant drug, but require a combination of serotonergic agents, such as an SSRI with an MAOI.[67] The intensity of the symptoms of serotonin syndrome vary over a wide spectrum, and the milder forms are seen even at nontoxic levels."

 

So the intensity of serotonin syndrome can vary. I also read that it is impossible to test serotonin syndrome anyway(like take labs) so it only can be pointed out from symptoms(agitation, akathasia, imsomnia ect.). If I understood correctly it all depend from receptors and how sensitive they are. When we start to taper it is impossible to know what kind of changes is happening to our receptors. If we start getting more and more emotions it sounds to me like receptors are waking up and becoming more sensitive  so if you in that condition updose the stimulus can be so much bigger than in previous state where the receptors have been more numbed and you end up on toxic levels of serotonin. 

 

This is what mm100 wrote in an other thread:

 

"it seems to me that the problems may start due to the UPREGULATION of the serotonin receptors after discontinuing the drug, and this is also why taking the drug again will not help as the serotonin system is far too sensitized (upregulated)"


Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 


#86 Newbeginning

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Posted 26 September 2016 - 02:56 AM

 

Serotonin Syndrome is a very serious condition caused by toxic level of serotonin in the brain.  It is NOT caused by a small updose when a person is taking a minuscule dose. Because of the nature of the drugs WD symptoms, side effects and serotonin syndrome will have some things in common, but WD symptoms and side effects are not serotonin syndrome.

 

Half life is only one small factor in determining blood level steady state.  The 4 day rule takes into account half life, absorption rates, metabolic rates, dosing schedule, the aggregate experience of thousands of case histories and many other factors. After an increase in dosage it can take several weeks to many months to stabilize. During that time it is recommended that a person not change dose until they have stabilized. To do so increases the risk of further destabilization.  Also note that stabilization does not mean symptom free.  It means that the symptoms have evened out to a consistent level with no big swings either direction.

 

"Extremely high levels of serotonin can cause a condition known as serotonin syndrome, with toxic and potentially fatal effects. In practice, such toxic levels are essentially impossible to reach through an overdose of a single antidepressant drug, but require a combination of serotonergic agents, such as an SSRI with an MAOI.[67] The intensity of the symptoms of serotonin syndrome vary over a wide spectrum, and the milder forms are seen even at nontoxic levels."

 

So the intensity of serotonin syndrome can vary. I also read that it is impossible to test serotonin syndrome anyway(like take labs) so it only can be pointed out from symptoms(agitation, akathasia, imsomnia ect.). If I understood correctly it all depend from receptors and how sensitive they are. When we start to taper it is impossible to know what kind of changes is happening to our receptors. If we start getting more and more emotions it sounds to me like receptors are waking up and becoming more sensitive  so if you in that condition updose the stimulus can be so much bigger than in previous state where the receptors have been more numbed and you end up on toxic levels of serotonin. 

 

This is what mm100 wrote in an other thread:

 

"it seems to me that the problems may start due to the UPREGULATION of the serotonin receptors after discontinuing the drug, and this is also why taking the drug again will not help as the serotonin system is far too sensitized (upregula

 

I didn't know there were different degrees of Serotonin Syndrome. Since Serotonin can't be measured reliably, it is virtually impossible to differentiate an adverse reaction to an updose/reinstatement from mild Serotonin Syndrome, if the symptoms of the reaction mimic Serotonin Syndrome.

 

I don't think one can get Serotonin Syndrome at the low doses we are on when tapering. Even if the receptors are upregulating, if you didn't get Serotonin Syndrome on the full dose before any of your receptors were downregulated, you shouldn't get it at lower doses or with half of your receptors upregulated again.


  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivinganti...313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression

    March 27/2017: Anxiety improved; severe depression continues


#87 reachingforthestars

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Posted 27 September 2016 - 12:01 AM

I know that my conclusions are only speculations since no one knows what really is happening in our brains and to our receptors during taper and during withdrawal. I believe that my receptors have changed so much from what they used to be before ten years on SSRI that it is now possible for me to get serotonin toxicity on lower doses. For example in insulin resistance it doesn't matter are the insulin levels normal it only matters are the insulin receptors sensitive enough to insulin. But if the insulin receptors are sensitive then you can get easily poisoning even from a little too high level of insulin. So in a way I think that SSRI can make serotonin resistant (serotonin) receptors and nothing happens even on high doses (except treatment resistant depression eventually).


Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 


#88 LexAnger

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Posted 27 September 2016 - 12:54 AM

I agree with RFTS from first hand experience about how the body reacts to these drugs after a bad reaction, even I don't know much about the science behind it. I never had problems taking lexapro at high doses until lately My body feels the poison effects of even a tiny drop. The whole situation changed completely. It doesn't matter what we call it, it's very true indeed.
<p>2009 Mar.: lexapro 10mg for headache for 2 weeks.2009-2012: on and off 1/4 to 1/3 of 10mg2012 June--2013 Jan,: 1/4-1/3 of 10mg generic, bad jaw pain2013 Jan-Mar: 10 mg generic. severe jaw and head pain; Mar--Aug. started tapering (liquid ever since) from 10 to 5 (one step) then gradually down to 2.25 mg, first ever panic attack, severe head/jaw pain2013 Aug.: back to 2.75 mg; Nov: back to Brand Lex. 2.75mg -- 3mg, slight improvement with pain2014 June: stopped PPI, head pressure/numbness. up-dosed 4.5mg, severe reaction mental symptoms added on2014 Aug--2015 Aug: Micro taper down to 3.2mg, .025mg (<1%) cut holding 2-3 weeks.2015 Aug 15th, Accidental one dose of 4.2mg. worsening brain non-functional, swollen head, body, coma like, DR2016 Feb., started fast taper for the drug toxicity caused by the one dose of 4.2mg, dosing 10am through 11 pm everyday2/13--3.2mg, 3/15-- 2.9mg, 4/19-- 2.6mg, 6/26--2.2mg, 7/22 --1.9mg, 8/16--1.8mg,8/31--1.7m g, 9/13--1.6mg, 9/27--1.5mg, 10/8--1.4mg, 10/14--1.3mg, 11/1--1.2mg, 11/29--1.1mg, 12/12--1mg, 12/22--0.9mg2017: 1/7--0.8mg, 1/15--0.7mg, 1/17--0.6mg, 1/20--0.52, 1/21--0.4mg, 1/22--0.26, 1/23--0.2, sliding Down to 0.13mg by 2/13, then 0.07mg since 2/18, 0.06mg 2/20-3/17, 0.13mg 3/18

#89 woof

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Posted 18 October 2016 - 12:19 PM

You need to let your nervous system stabilize after reinstating. How long this might take depends on how long you've been off the drug and other factors. If you were off only a couple of days, you might stabilize for a month before trying to taper. If you've been off longer, to be safe, you should give your nervous system longer to stabilize, even if symptoms go away right away. If you've been off months, it might take months before you stabilize. Do not attempt to taper again until you feel symptom-free. (Cold turkey off another psych drug simultaneously compounds the situation.)

Hello Alto,

 

Thank you so very much for creating this site.  BTW, I actually grew up in SF and went to Woodrow Wilson High on Mansell, but I think it's closed now.

 

This statement above is such a great and very important piece of information. 

 

I was wondering if you think this post or something paraphrasing it may be appropriate to add to the first page of the Forum on tapering, where reinstatement is discussed in some detail.

 

I personally was pretty frantic when I first got to SA and didn't know my way around and has so much vital information, so I initially just read the Forums and did not see the post above until a few weeks ago.

 

Just my 2 cents,

You all are the best,

 

Most Respectfully and most Sincerely,

Woof


2004-2015 Cymbalta 20mg/d No problems at all with Cymbalta, I just wanted to get off of all meds.  Nov, 25 2015 CT 20mg/d Cymbalta (194 beads)   

Jan 2016 Reinstated 20mg/d Cymbalta (194 beads) 5 weeks after CT

Jan-April 2016 Held Cymbalta 20mg/d for 4 months. All wd sx's gone, except: 4/10 AM anxiety 9-1:30 only after 7:30 AM Cymbalta, 2/10 tinnitus & 2-4 AM waking then back to sleep. 

April 21 2016 Prematurely CUT -Cymbalta 20-18mg (194-19 = 175 beads) - AM anxiety resolved :)  May 21, 2016 cut to (158 beads) 16mg-stable,

July 04, 2016 cut to (143 beads) 14.5mg and had 10/10 wd sx's  Anxiety, Anhedonia, Anorexia, Fear, dysphoria, could not go back to sleep after 1:30 AM wake-up.

Nov 29th 2016 UPDOSED (41 beads) Cymbalta to 20mg (194 bead) all sxs except tinnitus virtually gone. 

I plan to stay on 20mg/d Cymbalta.  Nothing but improvement since updosing.  Stable with no anxiety and greatly improved sleep as of March 8th 2017

FEB 2016 STARTED Valium 25mg/d for the CT Cymbalta wd sxs.   August 2016 Increased Valium to 28mg/qhs, due wd sx's from July 4, 2016 Cymbalta cut.

Jan 1, 2017  Cut Valium 28mg qhs 28mg-3mg=25mg.    March 11,2017 25mg-2mg=23mg   Plan to decrease Valium 10% per 4 weeks as tolerated.  Fish oil

http://survivinganti...key-withdrawal/  Benzo Posts http://survivinganti...ta-wd-symptoms/

 

 


#90 woof

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Posted 22 December 2016 - 12:25 PM

You need to let your nervous system stabilize after reinstating. How long this might take depends on how long you've been off the drug and other factors. If you were off only a couple of days, you might stabilize for a month before trying to taper. If you've been off longer, to be safe, you should give your nervous system longer to stabilize, even if symptoms go away right away. If you've been off months, it might take months before you stabilize. Do not attempt to taper again until you feel symptom-free. (Cold turkey off another psych drug simultaneously compounds the situation.)

If one did not have problems with the AD in the first place.  Tapering off them may not be the best choice for that person.  My situation is admittedly a bit odd in that I just wanted off of all meds, because I thought it was a good thing.

 

Please see my intro below.  Hopefully this can be of some help to someone in a situation like myself. 

 

For over 10 years I never experienced any problems with 20mg/d Cymbalta, It actually helped my sleep.  I wish I never started it for my neck pain, but that is way in the past.  I arrogantly just wanted to get off of all meds.

 

It's been 4 weeks now since I fully updosed to 20mg/d Cymbalta, after 3, 10% cuts.  The first cut was good as my AM anxiety immediately went away, so I thought that tapering was right for me.

 

Now I believe Alto's words above are extremely wise and that the anxiety and insomnia would have resolved, given a few more months at my reinstated dose of 20mg/d; as is empirically evidenced by my current state.

 

I was so scared to updose by 41 beads, but I did have confidence in the 4 doctors I consulted with and they all independently concurred with the action I should take - take the full 20mg pill.

 

One of these MDs is one of the 3 most cited MD's on this site, as well as within the healthcare community. 

 

While 41 beads sounds like a lot, if you look at the exponential activity curve (which these MDs were all well aware of) in combination with my dose and the fact that I had had no problems with Cymbalta in the first place,  I took their advice.

 

With the exception of my 1-3/10 tinnitus all of my sxs have resolved at this point. 

 

All of my sx's just got better and better after I updosed to my original 20mg/d level.

 

After a full year my sleep finally has come back, anxiety is gone, appetite is great, BM's are normal, I can watch sports or anything I want on TV again and Anhedonia is gone :)

 

Unfortunately, now I have to taper off of 25mg/d of Valium which I was maintaining as I was tapering, but at least my mind seems quite a bit more stabilized.

 

I will be tapering slowly off of the Valium after about another month or so of stabilization.

 

Everyone on this site has been wonderful to me and I have learned so very much from all of you, this is without question the best online site. 

 

I just hope that this post may help others. 

 

Warmest Regards,

Woof :)  


2004-2015 Cymbalta 20mg/d No problems at all with Cymbalta, I just wanted to get off of all meds.  Nov, 25 2015 CT 20mg/d Cymbalta (194 beads)   

Jan 2016 Reinstated 20mg/d Cymbalta (194 beads) 5 weeks after CT

Jan-April 2016 Held Cymbalta 20mg/d for 4 months. All wd sx's gone, except: 4/10 AM anxiety 9-1:30 only after 7:30 AM Cymbalta, 2/10 tinnitus & 2-4 AM waking then back to sleep. 

April 21 2016 Prematurely CUT -Cymbalta 20-18mg (194-19 = 175 beads) - AM anxiety resolved :)  May 21, 2016 cut to (158 beads) 16mg-stable,

July 04, 2016 cut to (143 beads) 14.5mg and had 10/10 wd sx's  Anxiety, Anhedonia, Anorexia, Fear, dysphoria, could not go back to sleep after 1:30 AM wake-up.

Nov 29th 2016 UPDOSED (41 beads) Cymbalta to 20mg (194 bead) all sxs except tinnitus virtually gone. 

I plan to stay on 20mg/d Cymbalta.  Nothing but improvement since updosing.  Stable with no anxiety and greatly improved sleep as of March 8th 2017

FEB 2016 STARTED Valium 25mg/d for the CT Cymbalta wd sxs.   August 2016 Increased Valium to 28mg/qhs, due wd sx's from July 4, 2016 Cymbalta cut.

Jan 1, 2017  Cut Valium 28mg qhs 28mg-3mg=25mg.    March 11,2017 25mg-2mg=23mg   Plan to decrease Valium 10% per 4 weeks as tolerated.  Fish oil

http://survivinganti...key-withdrawal/  Benzo Posts http://survivinganti...ta-wd-symptoms/

 

 


#91 Timeman

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Posted 19 January 2017 - 05:00 PM

Help. I was on benzo for 15 years. Did a detox at a clinic 6 mos ago.  In the last three months I took mertazapine  to sleep. I had no idea!!! Then I decided the side effects were terrible I am confused by the taper idea and exactly how to safely reinstate. On metazapen 15 mg  for 3 mos. Went to 7.5 for three days. No sleep. Went on 15 mg. Felt like crap. Still decided to cut to 11.25 mgs. 14 days. quit. Six days, last of which, no sleep. Terrible!! ER. My doctor told me I needed it and to go back on 15mg. I did and slept last night. Woke up feeling very drugged and had anxiety attacks. Went  on the web and found this site. Read about reinstating at a smaller dose then I came off of.  Did 3.75 to see if I felt better. I think I do. But tonight is coming and I don't want to take anymore today if it will mess up any future. I thought I could slowly taper from here. Or do I up the dose and taper from that??  Help!! I am confused about how this works. 


2000  September start Xanax .05 mg  stop September 2002  start klonopin September 2002   November 2015 dose increased to 1mg x2   August 16 2016  STOP klonopin DETOX  11 days  took drug to detox but I can't remember what it was stopped drug 11 days August 27 th 2016 start August 27 gabapenton 100 mg 4x per day  increase to 300 3x   October 2016 stopped gabapenton Started mertazapen 15 mg October 1 2006 reduce December 27- 29 2016 7.5  updose December 30  reduced January 1 2017 11.25 mg mertazapine  Stopped January 13 January 19  Reinstated to current dose of 15mg
Note Taking supplements from the ROAD BACK  1500 MG omega 3  body calm  tart cherry and as of yesterday i ounce of tart cherry juice 2x per day
 

#92 scallywag

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Posted 19 January 2017 - 05:37 PM

Timeman, I've moved your second post to an introduction thread for you: Timeman: Reinstating mirtazapine?.

 

Please post updates and questions at that link.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results
Cymbalta (brand name), 60 mg 2012 - 2015; 20 mg to 7 mg in 2016, exact doses and dates in this post;
2017: 6.3 (58 beads) Feb. 1; 5.6 mg (52) Feb. 22; 5.4 mg (50) Mar. 15; 5.1 mg (47) Mar. 25; 4.9 mg (45) Apr. 5;
Current dose: 4.5 mg (42) 2017-Apr-14
+ Supplements: fish oil (1500 mg EPA/500 mg DHA), Vitamins: D3, K2, C; Minerals: Mg, Se, Cr, I, V
scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet