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Why taper? Paper demonstrates importance of gradual change in plasma concentration

tapering

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#37 btdt

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Posted 07 August 2014 - 01:37 PM

dcrmt, I hear and understand what you're saying, but I actually think it's more complicated than that. Biochemistry is incredibly complicated, and nowhere more complicated than in the nervous system. Every chemical reaction affects a cascade of reactions downstream, in complex feedback loops. Nothing is isolated. There are no separate compartments in the chemistry of the body.

 

It's tempting to try to simplify it and say "serotonin in the synapses does this thing, transporters do this thing, receptors do this thing" as if it were mechanical and predictable and those were all separate parts, but it's not. It is incredibly more complex than that. And that's just talking about synapses. You've got glial cells interacting with everything else, all of it reacting and responding in nanoseconds (literally), causing more reactions to happen elsewhere, causing cascades and loops which then feed back in multiple places. There is no neurotransmitter that acts in isolation. They all affect each other.

 

And although scientists talk about this stuff as if they understand it (well actually the REAL neuroscientists don't, mostly it's the psychiatrists, who are apparently not reading much neuroscience)--we understand probably less than 1% of what's actually going on. The state of the science is not very advanced, relative to what there is to learn.

 

We are conditioned to think using mechanical or computer analogies about this stuff, but that is simply not how it works. There are no separate compartments. Everything affects everything.

 

So the take-away point about these charts for me and probably for Alto as well, isn't really what piece is doing what. It's not really the effect of the drug--we find that the effects of the drugs themselves are highly variable in different individuals, even more so once they have some history of taking psych drugs of any kind, and that makes sense given the complexity involved.

 

The exciting take-away of these charts is that they make it so brilliantly, visually clear that the effects--whatever they may end up being--increase and decrease in an exponential fashion. We had observed this anecdotally, but to have the data and a visual graph is just absolutely brilliant and priceless. It makes it so much easier for people to understand why they must taper following an exponential/logarithmic curve rather than just a linear decrease. And we can show these charts to our doctors when they say "you're just taking 2 mg, that's such a low dose you can just stop." 

 

I'm thrilled to have this tool. I cannot thank you enough for bringing it here.

"We had observed this anecdotally, but to have the data and a visual graph is just absolutely brilliant and priceless. It makes it so much easier for people to understand why they must taper following an exponential/logarithmic curve rather than just a linear decrease. "

 

Could you say this is simpler terms.  

I left this thread long ago today I find it extremely confusing exponential/logarithmic curve... really what is that?

And I did try to look it up...

http://www.sosmath.c...og42/log42.html

Still it does not translate into anything understandable to my brain. 

 

And Alto this

 exponential decay in tapering is closer to the descending curve

Maybe I am just flat out stupid I don't know but I don't get what your trying to say. 

I thought the graphs showed the amount the body/brain could use had a limit beyond that limit it was a waste of the drug and who knows that the excess does to the body.  

And that tapering is easy at the start because the drug was in excess anyway which was off the graph... so effects were not felt till tapering reached the graph where affects were felt. 

I do worry that maybe others here especially new folks in hard withdrawal will have trouble with this jargon... I could be stupid often think I am.


WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivinganti...ng-myself-btdt/

There is a crack in everything ..That's how the light gets in :)


#38 Meimeiquest

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Posted 07 August 2014 - 02:36 PM

BTDT, you are so not stupid. I think it means what you think. As levels get lower, there is a much greater decrease in % of transporters affected for each little amount of drug taken away.
1st round Prozac 1989/90, clear depression symptoms. 2nd round Prozac started 1999 when admitted to dr. I was tired. Prozac pooped out, switch to Cymbalta 3/2006. Diagnosed with bipolar disorder due to mania 6/2006--then I was taken abruptly off Cymbalta and didn't know I had SSRI withdrawal. Lots of meds for my intractable "bipolar" symptoms.
Zyprexa started about 9/06, mostly 5mg. Tapered 4/12 through12/29/12
Wellbutrin. XL 300 mg started 1/07, tapered 1/18/13 through 7/8/13
Oxazepam mostly continuously since 6/06, 30mg since 12/12, tapered 1.17.14 through 8.26.15
11/06 Lithium 600mg twice daily, 2.2.14 400mg TID DIY liquid, 2.12.14 1150mg, 3.2.14 1100mg, 3.18.14 1075mg, 4/14 updose to 1100mg, 6.1.14 900 mg capsules 7.8.14 810mg, 8.17.14 725mg, 8.24.24 700mg...10.22.14 487.5mg, 3.9.15 475mg, 4.1.15 462.5mg 4.21.15 450mg 8.11.15 375mg, 11.28.15 362.5mg, back to 375mg four days later, 3.4.16 updose to 475 (too much going on to risk trouble)
9/4/13 Toprol-XL 25mg daily for sudden hypertension, tapered 11.12.13 through 5.3.14, last 10 days or so switched to atenolol
7.4.14 Started Walsh Protocol
56 years old

#39 btdt

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Posted 07 August 2014 - 05:15 PM

Thanks are you sure that is what it means or am I missing something important?


WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivinganti...ng-myself-btdt/

There is a crack in everything ..That's how the light gets in :)


#40 lionboy

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Posted 10 August 2014 - 10:27 AM

I also don't think you are stupid BTDT. I think we all have to be very careful when trying to draw any finite conclusions from a study such as this.
As Alto mentioned earlier in the thread, the findings here do appear to be indicative of the reason people need to slowly taper from these drugs however I would be very careful of drawing any firm conclusions from this.
As I understand it, nobody has proven a relationship between SERT occupancy and the way a person feels furthermore there is no accurate way of measuring seratonin in a living brain ?
This study is done by measuring seratonin in the gut then extrapolating the amount they think that means is in the brain.
In addition, new research suggests that seratonin levels decrease with age so you would therefore expect people to gradually get more depressed the older they get which of course doesn't happen.
The fact is that no one really understands the full mechanics of the effects these drugs have on the human brain.
This type of research will no doubt prove one day to be a part of the jigsaw but I really believe that is all it is, just one part of the jigsaw.
1999 50mg citalopram / celexa for anxiety and depression.
dec 2007 50mg - 40mg, march 2009 40mg - 30mg, july 2009 30mg - 20mg, aug 2009 20mg - 30mg, sept 2009 30mg - 20mg, jan 2010 20mg - 30mg, july 2010 30mg - 25mg (one 20mg and half a 10mg tablet), july 2010 - july 2013 25mg

July 2013 began tapering down in 1mg increments, dissolving the tablets in water and using a syringe as suggested by Rhi. Had a few hiccups along the way as can be seen in my thread.

End December 2013, now down to 11.25mg.
Dec 2013 to present day still on 11.25 mg. I have hit, what Professor Healy terms, a shelf. I became extremely destabilised when I reduced from 12.25mg to 11.25mg. Only now, after some 15 months am I starting to really recover from it.

#41 lionboy

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Posted 10 August 2014 - 12:04 PM

* I may be wrong, regarding how they measure SERT !
I started to read into it but lost the will to live.
1999 50mg citalopram / celexa for anxiety and depression.
dec 2007 50mg - 40mg, march 2009 40mg - 30mg, july 2009 30mg - 20mg, aug 2009 20mg - 30mg, sept 2009 30mg - 20mg, jan 2010 20mg - 30mg, july 2010 30mg - 25mg (one 20mg and half a 10mg tablet), july 2010 - july 2013 25mg

July 2013 began tapering down in 1mg increments, dissolving the tablets in water and using a syringe as suggested by Rhi. Had a few hiccups along the way as can be seen in my thread.

End December 2013, now down to 11.25mg.
Dec 2013 to present day still on 11.25 mg. I have hit, what Professor Healy terms, a shelf. I became extremely destabilised when I reduced from 12.25mg to 11.25mg. Only now, after some 15 months am I starting to really recover from it.

#42 btdt

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Posted 13 August 2014 - 04:50 PM

Thanks Lionboy I get trying to sort out this sort of thing can cause one to lose the will to live... 

happens to me all the time and I leave it or just forget about it naturally with my forgetful brain. 

That too happens a lot. 

I guess we are just light years behind what we thought we knew as a human race and taking drugs we have no business taking as nobody knows anything really about them  I wonder if it would make any sense to be frozen and defrosted in 3014... when they know how to fix me. If only all I loved would go with me. :) 

thanks again peace to you


WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivinganti...ng-myself-btdt/

There is a crack in everything ..That's how the light gets in :)


#43 Barbarannamated

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Posted 29 August 2014 - 08:26 AM

Because i have an underactive SERT gene, I was interested in how that plays in and found this in one of the citations:

Effects of Chronic Antidepressant Treatments on Serotonin Transporter Function, Density, and mRNA Level
http://m.jneurosci.o.../23/10494.short

Excerpt from abstract:

"Based on these results, it appears that the SERT is downregulated by chronic administration of SSRIs but not other types of antidepressants; furthermore, the downregulation is not caused by decreases in SERT gene expression."

I hope this is not deviating too far from main topic. I believe it may be a part of why some of us who have been on these drugs for many years experience poopout and/or greater difficulty in discontinuation.
Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

#44 Rhiannon

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Posted 30 August 2014 - 10:24 PM


"We had observed this anecdotally, but to have the data and a visual graph is just absolutely brilliant and priceless. It makes it so much easier for people to understand why they must taper following an exponential/logarithmic curve rather than just a linear decrease. "

 

Could you say this is simpler terms.  

I left this thread long ago today I find it extremely confusing exponential/logarithmic curve... really what is that?

And I did try to look it up...

http://www.sosmath.c...og42/log42.html

"

 

I can't explain graphs and math here in a written format--do you know any math people?

 

Any math teacher or tutor, or anyone who likes math and understands functions and graphs of functions (basic college algebra or second year high school algebra), could explain to you the difference between a linear function and an exponential function. And they could explain how those graphs demonstrate that you have to make smaller cuts at lower doses, you can't just make the same size cuts all the way down.

 

It's just too visual, I would have to make a video or something, and even then really you need someone you can ask to stop and show you stuff where it gets confusing. 


Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease" as I was told. Long and tragic story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything.

 

Now tapering, ironically (but not surprisingly) healthier and more functional than I ever was during the years on the "meds," even with withdrawal (usually fairly mild at this slow pace).

 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 14 2011:   86 mg Neurontin   144 Lamictal,    5.5 Celexa   0.42 Xanax      1.9 mg Valium

Feb 16 2012:   10 mg Neurontin   115 Lamictal     3.7 Celexa   0.285 Xanax     2.0 Valium

Feb 22 2013:   86 Lamictal    2.05 Celexa       0.23 Xanax      1.8 Valium

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

Now:                43                    0.625                 0.0775            1.3

 

I'm not a doctor. Any advice I give is just my civilian opinion.


#45 Rhiannon

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Posted 20 November 2014 - 11:18 AM

Do you think this is the case for gaba and benzodiazepines?

 

This particular paper (which unfortunately the link doesn't work to any more) didn't cover benzos, but experientially, anecdotally, people have always found that the taper with those has to go slower as the doses get lower too. Same kind of thing where you have to cut by a percentage of the current dose not by constant increments. So presumably it's something similar going on.


Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease" as I was told. Long and tragic story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything.

 

Now tapering, ironically (but not surprisingly) healthier and more functional than I ever was during the years on the "meds," even with withdrawal (usually fairly mild at this slow pace).

 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 14 2011:   86 mg Neurontin   144 Lamictal,    5.5 Celexa   0.42 Xanax      1.9 mg Valium

Feb 16 2012:   10 mg Neurontin   115 Lamictal     3.7 Celexa   0.285 Xanax     2.0 Valium

Feb 22 2013:   86 Lamictal    2.05 Celexa       0.23 Xanax      1.8 Valium

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

Now:                43                    0.625                 0.0775            1.3

 

I'm not a doctor. Any advice I give is just my civilian opinion.


#46 drummerseve

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Posted 30 December 2014 - 02:12 PM

 

Hi, I thought I'd share this as it's quite relevant, not 100% sure if this is the right subforum, will post in both this and research.
 
 
the pretty pictures are from page 4 onwards.
 
 
What these fellows did here, was attempt to measure serotonin transporter occupancy at various doses for 5 different drugs. (Zoloft, celexa  paxil, effxor and Prozac, not in that order). They fit curves for both the oral doses and blood concentrations.
 
Long story short for anyone who doesn't know, SSRI’s ‘work’ by binding to the serotonin transporter protein (SERT) and stopping it doing it’s normal thing (reuptake of post-synaptic serotonin), resulting in serotonin hanging around for longer.
 
Now a couple of interesting things:
-at minimum therapeutic doses in every case, there was about 80% SERT occupancy. That shocked me personally. Even the minimum doses are locking down 80% of your brains reuptake ‘capacity’. Higher doses do more but it’s obviously not linear – they actually have plotted curves, and they’re quite a good fit statistically, particularly for the blood concentrations. Really good in fact. 
Point here though is that there’s a long way between 0% at no drug and 80% at the minimum dose.
 
-the curves man, look at the curves. This gives a fairly good indication of why some people find tapering necessary. You NEED a percentage taper just to get a linear decrease in SERT occupancy. Linear decreases in dose will actually hit you with exponentially increasing drops in SERT occupancy, particularly drops between the minimum therapeutic dose and 0
 
Basically, this paper provides a real basis for percentage reductions in dose when discontinuing SSRI’s.
I realize I'm kinda preaching to the converted and telling people what they already know, but it seems there may actually be a real reason why some people find it necessary to do these percentage tapers to get off SSRI's.
 
 
Caveat: I have no idea what the relationship between SERT occupancy and post synaptic serotonin is, it’s probably not linear since if it was higher doses would have basically no effect, but this is nevertheless very interesting to look at.
They were only looking at one part of the brain but pointed out it correlated strongly to elsewhere.
 
Administrator's note: Also see http://survivinganti...mography-study/
 
Can you explain that to me like im 8? hahah. I cant comprehend half of this stuff.

Put on Paxil 20mg for anxiety in 1998. Crapped out fall of 2005. Taken off cold turkey by my Dr.Put on Effexor xr 150mg within a week. Crapped out summer 2012.  Dosage was upped to 225mg.  Symptoms worsened.  Quit smoking and started a slow taper at 10% every 4-5 weeks or so.  At around 25mg started developing ocd like symptoms(intrusive thoughts mainly)Slowed taper down.  Symptoms remain.  Got down to 2mg and quit the Effexor.  I was fine for a few weeks and was hit with a wall of symptoms. (I had started tapering my benzo at this point not knowing I shoulda waited much longer) I then hit with a wall of WD symptoms.  Debilitated.  Reinstated December 30th, 10 beads.  Felt really messed up.  Dropped to 5 beads.  Remaining until stable.

Started Klonopin 1mg once a day during my taper. Summer 2014. (At this time I was at 25mg Effexor) Dropped to .75mg of Klonopin for 3 weeks. Wd symptoms worsened. Klonopin is back to 0.5mg twice daily. Waited for a month and made the mistake of starting a slow taper(what I thought was slow) at 6.25 percent for one week but had insane nightmares. It was too early to try and taper.  I went back to .5mg twice daily but seem to be having interdose wd. Symptoms are Sleep disturbances, depression and weird chest pains. Working my way to .25 mg spread evenly 4 times a day. Gonna stabilize and start a taper after 6 months er so.


#47 DLB

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Posted 22 March 2015 - 06:51 AM

not sure how to read this but the curves are similar. Such a drastic immediate curve.
http://www.researchg...63d9a000000.pdf. Click on full text to read
Paxil start September 2003 due to Fluoroquinolone adverse reaction that I wish doc. knew what it was. 10mg. most of the time with a few short runs of 20mg. FAST tapered 3 times and finally hit poop out or a reaction to nsaid's in Nov.2013. Started a 10% taper Jan. 2014 and have been ok until Sept 14 and went through a short hell. Now plodding through and looking for the light with unrelenting insomnia and pain, fog, loss of interests....<p>12/20/14 - .8mg.
1/01/15 - .75 mg.
1/15/15 - .42 mg. better sleep now, hope it continues...
2/11-15 - .25 mg. doing really good!! 2 weeks feel 85% of old me!
3/17/15 .14 mg. Knee pain bad!
4/07/15 .05 mg. this is so small now that I am estimating and just licking it off palm small as a "." And I'm using small text..
4/13/15 NOTHING !!!! Took my last little micro dose on 4/12/15. 😃👍👍👍

#48 felin

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Posted 03 April 2015 - 09:33 AM

The pdf on first post in this thread didn't work for me so I looked for article via Google. Is this the same/correct one? Don't want to post something that does not apply.

 

Serotonin Transporter Occupancy of Five Selective Serotonin Reuptake Inhibitors at Different Doses: An [11C]DASB Positron Emission Tomography Study


All that I can give you at this point is what I can remember. Will add more after I've called the zillions of doctors that I've had over the past 30 years. I have spent all day calling old insurance co's, etc to get the long list of doctors names that I once had, so will update this someday. Unfortunately, most records are no longer available. :(

 

Haven't started tapering yet. Will.

 

Currently am on:

  • Cymbalta 60 mg/ daily - actually taking the generic for it. It is called Duloxetine
  • Wellbutrin XL 150 mg/ daily - taking the generic for this. It is called Bupropion XL
  • Naturethroid 3/4 grain/ daily - this is a natural dessicated thyroid med for my Hypothyroidism
  • Relpax only take as needed - for migraines

FINALLY started tapering Cymbalta by 5% reduction May 5, 2016


#49 tyson

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Posted 27 August 2015 - 08:49 PM

Hi, everyone. 

I'm still with my son who is doing better with his withdrawal reaction from zyprexa. At this time, he is on 2.5mg with 5-8% reduction every 6-8 weeks. He is not taking any supplement or other drugs with this drug. Now my question is we are getting to the cliff getting down to the yooyo position according to the blood plasma concentration graph. I'm still don't understand the dopamine/ seratonin relation to the graph and how I would see zyprexa in relation to my reduction.

Does anyone know what this relation is and explain that in simple way. Also, is zyprexa acts as antipressant when it gets lower level. 

I'm confused about the graph detail. 

thanks 



#50 Skyler

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Posted 28 August 2015 - 05:08 AM

Why is it important to know if Zyprexa acts as an anti-depressant at lower doses? The lower the dose, the more need there is for caution with the taper, and your son seems to be tapering at a most judicious rate.

 

Perhaps someone else can respond better... but I don't know why you need to understand in detail?  This is very complicated data, and I am not familiar with all the neuroscience, but I do get the gist of what is being discussed... that along with the positive tapering experience I have had by following the advice on this forum is enough validation for me.


As always, LISTEN TO YOUR BODY! A proud supporter of the 10% (or slower) rule.

 

Requip - 3/16 ZERO  Total time on 25 years.

 

Lyrica: 8/15 ZERO Total time on 7 or 8 yrs.

BENZO FREE 10/13 (started tapering 7/10)  Total time on 25 years.

 

Read my intro thread here, and check the about me section.  "No matter how cynical you get, it's almost impossible to keep up." Lily Tomlin

 

 


#51 Meimeiquest

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Posted 28 August 2015 - 10:20 AM

Hi, everyone. 
I'm still with my son who is doing better with his withdrawal reaction from zyprexa. At this time, he is on 2.5mg with 5-8% reduction every 6-8 weeks. He is not taking any supplement or other drugs with this drug. Now my question is we are getting to the cliff getting down to the yooyo position according to the blood plasma concentration graph. I'm still don't understand the dopamine/ seratonin relation to the graph and how I would see zyprexa in relation to my reduction.
Does anyone know what this relation is and explain that in simple way. Also, is zyprexa acts as antipressant when it gets lower level. 
I'm confused about the graph detail. 
thanks


I am having problems pasting a link as I cracked my iPad, but you can look olanzapine up on Wikipedia for some idea. There is a chart at the bottom of how it affects different neurotransmitter systems. Practically, I did not have any depression per se during my taper of Zyprexa, but lots of insomnia, loss of emotional control in every way, that horrible head feeling, and, at the very end, minor tardive dyskinesia. And seeing things and hearing simple sounds that weren't there, and many memories coming back whenever I wasn't occupied with something else, it was like a video scrapbook. And hypomania at the end. Otherwise it was a piece of cake :). For me, the symptoms started when I got below 2.5mg.
1st round Prozac 1989/90, clear depression symptoms. 2nd round Prozac started 1999 when admitted to dr. I was tired. Prozac pooped out, switch to Cymbalta 3/2006. Diagnosed with bipolar disorder due to mania 6/2006--then I was taken abruptly off Cymbalta and didn't know I had SSRI withdrawal. Lots of meds for my intractable "bipolar" symptoms.
Zyprexa started about 9/06, mostly 5mg. Tapered 4/12 through12/29/12
Wellbutrin. XL 300 mg started 1/07, tapered 1/18/13 through 7/8/13
Oxazepam mostly continuously since 6/06, 30mg since 12/12, tapered 1.17.14 through 8.26.15
11/06 Lithium 600mg twice daily, 2.2.14 400mg TID DIY liquid, 2.12.14 1150mg, 3.2.14 1100mg, 3.18.14 1075mg, 4/14 updose to 1100mg, 6.1.14 900 mg capsules 7.8.14 810mg, 8.17.14 725mg, 8.24.24 700mg...10.22.14 487.5mg, 3.9.15 475mg, 4.1.15 462.5mg 4.21.15 450mg 8.11.15 375mg, 11.28.15 362.5mg, back to 375mg four days later, 3.4.16 updose to 475 (too much going on to risk trouble)
9/4/13 Toprol-XL 25mg daily for sudden hypertension, tapered 11.12.13 through 5.3.14, last 10 days or so switched to atenolol
7.4.14 Started Walsh Protocol
56 years old

#52 Sarabera

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Posted 22 December 2015 - 12:24 PM

These graphs are just a brilliant thing for us in withdrawal. I was delighted to see my old buddy amitryptiline analyzed in the one study ("Neurotransmitter receptor and transporter binding profile of antidepressants and their metabolites"). I'm going to chew through that study when I have time. But as pointed out--the curves are all almost identical! Has anyone used this information to create a schedule for withdrawal that will provide even plasma level drops (or % 0f 5HTT binding)--say a 5% plasma level drop with each dosage drop? I'm going to graph that out and see what that would look like.

 

This explains a lot about the difficulties I have had with withdrawal, even though my dosages have been fairly low. I had very little issue with bouncing around between 12.5-25mg, or even 36mg at times. But trying to CT from even a low dose of 6mg. has been impossible for me. I went from 12.5 to 6mg this summer, and never apparently got stabilized--lots of issues with insomnia, stomach issues, etc...Looking at these graphs, I can clearly see why that has been so difficult!


1975--first signs of depression

1981--started on imipramine (Tofranil) for IBS and depression

1983-1986--severe depression, rotated through several drugs, on MAOI for one year, eventually back to tricyclics

1986-1994--chronic low grade depression, on tricyclics

1994-96--severe depression, rotated through several drugs inc. Prozax, Effexor, etc..

1996-2013--chronic low grade depression, SAD, on amitryptiline usual dose 12.5-25mg

     flurazepam (Dalmane) as needed for insomnia

2013--developed temazepam (Restoril) dependance for 2 months, tapered off over 1 month

   started bio-identical progesterone 5 mg., depression has lifted completely to this day

March 2016--forced to c/t both amitryptiline and flurazepam, zolpidem not helpful

reinstated small dose (.5 mg) amitryptiline due to stomach issues and tapering w/titration

June 19th--jumped from amitryptiline--drug free!


#53 Brain

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Posted 16 January 2016 - 11:17 PM

Are curves of this sort available for sertraline?


KEY: Drug [total mass ingested] @CurrentDoseMaxDose (time span). Details.
Zoloft [1kg] @60250 (1998-present). 250mg most of the time. Starting Spring of 2009, tapered by 25mg steps down to 25mg/day by Oct 2010. Emotional crisis prompted return to 200mg by end of 2010. Reduced to 150mg in Sep 2012. Dropped to 125mg 1 April 2013. Dropped to 100mg around 1 June 2013. Dropped to 90mg 5 Dec 2014. @80mg 5 Jan 2015. @70mg 5 Feb 2015. @60mg 5 Mar 2015. @50mg 5 Apr 2015. @45mg 7 Sep 2015. @40mg 5 Oct 2015. @35mg 1 Nov 2015. @30mg 1 Dec 2015. @25mg 29 Dec 2015.
Wellbutrin XL [.864kg] @150300 (2004-present). Started at 150mg, quickly ramped up to 300mg. Dropped to 150mg in summer of 2010. Emotional crisis prompted return to 300mg by end of 2010. Dropped to 150mg 9 Apr 2014.
Klonopin [2.52g] @01 (1998-2005).
Paxil (1997-1998).


#54 LexAnger

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Posted 18 January 2016 - 12:17 AM

Are curves of this sort available for sertraline?


Figure 3 in the linked publication in the first post of this thread.
<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

#55 Altostrata

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Posted 18 January 2016 - 11:26 AM

Other antidepressants have been similarly analyzed in other papers. The curves are all similar.


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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#56 SkyBlue

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Posted 05 February 2016 - 08:45 PM

This is absolutely fascinating. 

 

I just joined Surviving ADs and someone showed me the link to this page.  
 
I was wondering if you could help me understand the SERT occupancy concept -- or more specifically, the idea that 
I think that is exactly what is going on with me, and I would love to understand it.
 
The study talks about "minimum therapeutic doses," but I am on only 1.2 mg (!!!) of Paxil and still having extreme difficulty with each tiny dose decrease. I hardly think that 1.2 mg can be considered a therapeutic dose. 
 
So  Altostrata, from your clear explanation, I think what was true for me is that at 60 mg Paxil, 50 mg., 40 mg., 30 mg, no problems with tapering: this was past the saturation point for my receptors, and I wasn't yet hitting my uh-oh point. For me "uh-oh" started at 20, and has been difficult since. 
 
"-at minimum therapeutic doses in every case, there was about 80% SERT occupancy. Even the minimum doses are locking down 80% of your brains reuptake ‘capacity’."
Point here though is that there’s a long way between 0% at no drug and 80% at the minimum dose."
 
Looking at the chart for Paxil/paroxetine, where I am (1.2 mg) there is still 40% SERT occupancy. Well, hello!!!! No *wonder* this has been so difficult. And I can't believe my doctor told me I could "probably just stop" Paxil when I got to 5 mg. !!!!!!
 
What does 40% SERT capacity mean, exactly? That 40% of my neurons are still having serotonin reuptake inhibited by Paxil? 
 
Thanks!!

Long story short: After 18 years on Paxil, "tapered" in July 2015 from 20 to 10 to 5 mg in a month, at doctor's advice. = Essentially a cold-turkey.

*Current*: March: 0.82 mg Paxil. Jan 1:  .88 mg, baby!! …. August 31: Less than 1mg Paxil! ... July 30: 1 mg Paxil! ! ! And 100 mg Zoloft unfortunately!!  

-------------------------------------------------------------------------------------------

On Paxil since 1996--anxiety & depression likely caused by (then-undiagnosed) under-eating / eating disorder. 

Rapid "taper" July 2015 and started Zoloft as a "cross-taper". Feb 2016: Found SA!! As of June 2016: Doing 2% cuts (Brassmonkey Slide!). 

Now: fish oil, magnesium; protein; exercise; healthy fats; acupuncture, meditation, & a new doctor.  I am in recovery from an eating disorder!!!  ***Have you had a sleep study?***    *Feel free to message me if I don't respond to a forum thread.* 


#57 Altostrata

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Posted 06 February 2016 - 10:16 AM

"Therapeutic doses" means the dosages found in clinical studies to reduce symptoms of "depression." These tend to be the tablet dosages available, e.g. 10mg, 20mg, 30mg Paxil.
 
(Whether the dosages actually do reduce symptoms of "depression" has produced a huge volume of literature critical of psychiatric drug development.)
 
Although you'll see many references to "therapeutic doses" in journal articles, they are a hypothetical construct, the drug companies' best guesses at what will "work" for the largest number of people. In fact, these are very strong drugs and probably commonly dosed too high, resulting in excess SERT occupancy.
 
These drugs are psychoactives. Some people feel an effect at very low dosages. SERT occupancy is only one factor in causing the neurological changes leading to these effects.
 
If you have been on a drug such as Paxil for a long time, it has caused changes in your nervous system far beyond SERT occupancy. It has changed the inter-relationship of all your hormonal systems, the functioning of your digestive system, your sleep pattern, etc. When you get down to a low dose, which may mean partial SERT occupancy, the rest of your body has to adjust. It is this adjustment that causes withdrawal symptoms.
 
In addition, paroxetine in particular is a very difficult drug to quit, perhaps the worst of all the antidepressants. This is probably because of its effects beyond SERT. For example, it is the SSRI that is the most anti-cholinergic, directly affecting an entire autonomic system.

 

See “It’s Anticholinergic” – What Does That Mean? http://pro.psychcent...an/002836.html#

 

In medical school pharmacology courses, many of us were taught about cholinergic effects with the mnemonic “SLUD”: Salivation, Lacrimation, Urination, Defecation. I suggest augmenting this with a “C” standing for “Cognition.” If ACh facilitates SLUDC, drugs that are anticholinergic – for example, the tricyclics, Paxil (paroxetine), Cogentin (benztropine), Artane (trihexyphenydil), and Benadryl (diphenhydramine) – are “Anti-SLUD-C.” This means that they cause dry mouth, dry eyes (and blurry vision), urinary retention, constipation, and confusion.

 


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.

#58 SkyBlue

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Posted 06 February 2016 - 03:30 PM

Dear Alto, 

 

Thanks very much for your reply. It is very eye-opening to think about the far-reaching effects of Paxil. It makes me glad I am 

a) getting off of it and B) doing so sloooowly.

 

Ah, yes -- Joseph Glenmullen in his amazing book Surviving Antidepressants talks about the "anticholinergics" such as Paxil, and that this quality is what makes Paxil so difficult to get off. 

 

Just made a donation to this forum. What an awesome and important place. Thanks again.


Long story short: After 18 years on Paxil, "tapered" in July 2015 from 20 to 10 to 5 mg in a month, at doctor's advice. = Essentially a cold-turkey.

*Current*: March: 0.82 mg Paxil. Jan 1:  .88 mg, baby!! …. August 31: Less than 1mg Paxil! ... July 30: 1 mg Paxil! ! ! And 100 mg Zoloft unfortunately!!  

-------------------------------------------------------------------------------------------

On Paxil since 1996--anxiety & depression likely caused by (then-undiagnosed) under-eating / eating disorder. 

Rapid "taper" July 2015 and started Zoloft as a "cross-taper". Feb 2016: Found SA!! As of June 2016: Doing 2% cuts (Brassmonkey Slide!). 

Now: fish oil, magnesium; protein; exercise; healthy fats; acupuncture, meditation, & a new doctor.  I am in recovery from an eating disorder!!!  ***Have you had a sleep study?***    *Feel free to message me if I don't respond to a forum thread.* 


#59 Altostrata

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Posted 06 February 2016 - 04:03 PM

You're very welcome.


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.

#60 LukeZoloft

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Posted 06 February 2016 - 04:12 PM

Hi Alto I was just wondering, what are SSRI's made of?

 

does the majority of there ingredients come from plants?

 

I recently learnt that benzodiazepines are made from substances found in broccoli  



#61 grandmaD

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Posted 13 March 2016 - 06:55 PM

.. As levels get lower, there is a much greater decrease in % of transporters affected for each little amount of drug taken away.

What exactly does this mean please?  What are "transporters" in simple language?


1995                20mg Aropax/Paxil for pain.  2000-2004 - Years of tapering and up-dosing (fast) (resultant suffering)

2004-2007       Daily 20mg

2008                Switching to Endep, Lexapro and then Esipram (hell!)

2009                20mg Aropax.  Tried skipping doses for a year (more hell!)

                        2010                10mg.  10% taper.  Lasted 4 months. Crashed again

2011                5% taper. 9mg-7mg (hell got even worse!)

2012                2.5% taper.  6.6mg – 5.6mg (worser still & unbearable)

2013                5% taper.  Big mistake.  5.5mg – 4.6mg  (even worserer)

2014                2.5% taper.  4.9mg – 4.5mg (worst year ever for w/d by far, plus gall surgery-developed arrythmia

2015                2.5% taper.  4.4mg - 4.0mg (gall surgery/anaesthetic continued to make things even worse)

2016                2.5% taper.  3.9mg  Feb 3.8   Mar 3.7  May 3.6   Jul 3.5 (finally imp. from gall surgery)

2017                2.5% taper.  Jan 3.4;   Mar 3.35;


#62 grandmaD

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Posted 13 March 2016 - 06:58 PM

Because i have an underactive SERT gene, I was interested in how that plays in and found this in one of the citations:

Effects of Chronic Antidepressant Treatments on Serotonin Transporter Function, Density, and mRNA Level
http://m.jneurosci.o.../23/10494.short

Excerpt from abstract:

"Based on these results, it appears that the SERT is downregulated by chronic administration of SSRIs but not other types of antidepressants; furthermore, the downregulation is not caused by decreases in SERT gene expression."

I hope this is not deviating too far from main topic. I believe it may be a part of why some of us who have been on these drugs for many years experience poopout and/or greater difficulty in discontinuation.

Please say in simple terms, if possible, what a SERT gene is and what "downregulated" means.  I gather by "chronic" they mean long term use.


1995                20mg Aropax/Paxil for pain.  2000-2004 - Years of tapering and up-dosing (fast) (resultant suffering)

2004-2007       Daily 20mg

2008                Switching to Endep, Lexapro and then Esipram (hell!)

2009                20mg Aropax.  Tried skipping doses for a year (more hell!)

                        2010                10mg.  10% taper.  Lasted 4 months. Crashed again

2011                5% taper. 9mg-7mg (hell got even worse!)

2012                2.5% taper.  6.6mg – 5.6mg (worser still & unbearable)

2013                5% taper.  Big mistake.  5.5mg – 4.6mg  (even worserer)

2014                2.5% taper.  4.9mg – 4.5mg (worst year ever for w/d by far, plus gall surgery-developed arrythmia

2015                2.5% taper.  4.4mg - 4.0mg (gall surgery/anaesthetic continued to make things even worse)

2016                2.5% taper.  3.9mg  Feb 3.8   Mar 3.7  May 3.6   Jul 3.5 (finally imp. from gall surgery)

2017                2.5% taper.  Jan 3.4;   Mar 3.35;


#63 grandmaD

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Posted 13 March 2016 - 07:01 PM


 
What does 40% SERT capacity mean, exactly? That 40% of my neurons are still having serotonin reuptake inhibited by Paxil? 
 
Thanks!!

 

Did this question get answered yet?  Forgive me if I missed it!


1995                20mg Aropax/Paxil for pain.  2000-2004 - Years of tapering and up-dosing (fast) (resultant suffering)

2004-2007       Daily 20mg

2008                Switching to Endep, Lexapro and then Esipram (hell!)

2009                20mg Aropax.  Tried skipping doses for a year (more hell!)

                        2010                10mg.  10% taper.  Lasted 4 months. Crashed again

2011                5% taper. 9mg-7mg (hell got even worse!)

2012                2.5% taper.  6.6mg – 5.6mg (worser still & unbearable)

2013                5% taper.  Big mistake.  5.5mg – 4.6mg  (even worserer)

2014                2.5% taper.  4.9mg – 4.5mg (worst year ever for w/d by far, plus gall surgery-developed arrythmia

2015                2.5% taper.  4.4mg - 4.0mg (gall surgery/anaesthetic continued to make things even worse)

2016                2.5% taper.  3.9mg  Feb 3.8   Mar 3.7  May 3.6   Jul 3.5 (finally imp. from gall surgery)

2017                2.5% taper.  Jan 3.4;   Mar 3.35;


#64 Meimeiquest

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Posted 13 March 2016 - 07:32 PM

Well, this is how I understand it: there are little transporters that carry serotonin back to their starting place after they carry a message across the space between neurons. Basically they are sent off and bind to the neuroreceptor, stimulating it. Then they are carried back by binding to the transporter (called SERT...serotonin reuptake transporter, I can't remember what E is) and riding back.

Selective Serotonin Reuptake Inhibitors (SSRI's) are the class of antidepressants that bind to those transporters so they can't carry serotonin and more serotonin therefore stays in the space between neurons. I think...it's late at night :). The lower the dose, the greater percent of transporters are blocked with each bit of medicine. As they get unblocked, there is less serotonin in the space and it is harder for those serotonin messages to get through to the receptors which have become less sensitive because they have been so flooded with serotonin when more transporters are blocked. This probably is a very inadequate and possibly inaccurate explanation...what questions do you have now? The bottom line is it is completely normal for tapering to get harder at the end.
1st round Prozac 1989/90, clear depression symptoms. 2nd round Prozac started 1999 when admitted to dr. I was tired. Prozac pooped out, switch to Cymbalta 3/2006. Diagnosed with bipolar disorder due to mania 6/2006--then I was taken abruptly off Cymbalta and didn't know I had SSRI withdrawal. Lots of meds for my intractable "bipolar" symptoms.
Zyprexa started about 9/06, mostly 5mg. Tapered 4/12 through12/29/12
Wellbutrin. XL 300 mg started 1/07, tapered 1/18/13 through 7/8/13
Oxazepam mostly continuously since 6/06, 30mg since 12/12, tapered 1.17.14 through 8.26.15
11/06 Lithium 600mg twice daily, 2.2.14 400mg TID DIY liquid, 2.12.14 1150mg, 3.2.14 1100mg, 3.18.14 1075mg, 4/14 updose to 1100mg, 6.1.14 900 mg capsules 7.8.14 810mg, 8.17.14 725mg, 8.24.24 700mg...10.22.14 487.5mg, 3.9.15 475mg, 4.1.15 462.5mg 4.21.15 450mg 8.11.15 375mg, 11.28.15 362.5mg, back to 375mg four days later, 3.4.16 updose to 475 (too much going on to risk trouble)
9/4/13 Toprol-XL 25mg daily for sudden hypertension, tapered 11.12.13 through 5.3.14, last 10 days or so switched to atenolol
7.4.14 Started Walsh Protocol
56 years old

#65 grandmaD

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Posted 14 March 2016 - 12:45 AM

Thanks for your description, however  am still confused!  Transporters sound like buses going to and fro taking serotonin but get hijacked or something...

 

Not to worry, I perfectly understand your last sentence that the lower we go the harder it is and I constantly need to to remember that!  It is still very interesting how all these things work - and don't work when they aren't in their "right order" and just shows we shouldn't play around with our brain with drugs.


1995                20mg Aropax/Paxil for pain.  2000-2004 - Years of tapering and up-dosing (fast) (resultant suffering)

2004-2007       Daily 20mg

2008                Switching to Endep, Lexapro and then Esipram (hell!)

2009                20mg Aropax.  Tried skipping doses for a year (more hell!)

                        2010                10mg.  10% taper.  Lasted 4 months. Crashed again

2011                5% taper. 9mg-7mg (hell got even worse!)

2012                2.5% taper.  6.6mg – 5.6mg (worser still & unbearable)

2013                5% taper.  Big mistake.  5.5mg – 4.6mg  (even worserer)

2014                2.5% taper.  4.9mg – 4.5mg (worst year ever for w/d by far, plus gall surgery-developed arrythmia

2015                2.5% taper.  4.4mg - 4.0mg (gall surgery/anaesthetic continued to make things even worse)

2016                2.5% taper.  3.9mg  Feb 3.8   Mar 3.7  May 3.6   Jul 3.5 (finally imp. from gall surgery)

2017                2.5% taper.  Jan 3.4;   Mar 3.35;


#66 grandmaD

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Posted 14 March 2016 - 11:10 PM

If you have been on a drug such as Paxil for a long time, it has caused changes in your nervous system far beyond SERT occupancy. It has changed the inter-relationship of all your hormonal systems, the functioning of your digestive system, your sleep pattern, etc. When you get down to a low dose, which may mean partial SERT occupancy, the rest of your body has to adjust. It is this adjustment that causes withdrawal symptoms.
 
In addition, paroxetine in particular is a very difficult drug to quit, perhaps the worst of all the antidepressants. This is probably because of its effects beyond SERT. For example, it is the SSRI that is the most anti-cholinergic, directly affecting an entire autonomic system.

 

See “It’s Anticholinergic” – What Does That Mean? http://pro.psychcent...an/002836.html#

 

 

 

What Alto posted here is good and helps with understanding, thanks


Edited by JanCarol, 01 May 2016 - 06:07 AM.
fixed quotes

1995                20mg Aropax/Paxil for pain.  2000-2004 - Years of tapering and up-dosing (fast) (resultant suffering)

2004-2007       Daily 20mg

2008                Switching to Endep, Lexapro and then Esipram (hell!)

2009                20mg Aropax.  Tried skipping doses for a year (more hell!)

                        2010                10mg.  10% taper.  Lasted 4 months. Crashed again

2011                5% taper. 9mg-7mg (hell got even worse!)

2012                2.5% taper.  6.6mg – 5.6mg (worser still & unbearable)

2013                5% taper.  Big mistake.  5.5mg – 4.6mg  (even worserer)

2014                2.5% taper.  4.9mg – 4.5mg (worst year ever for w/d by far, plus gall surgery-developed arrythmia

2015                2.5% taper.  4.4mg - 4.0mg (gall surgery/anaesthetic continued to make things even worse)

2016                2.5% taper.  3.9mg  Feb 3.8   Mar 3.7  May 3.6   Jul 3.5 (finally imp. from gall surgery)

2017                2.5% taper.  Jan 3.4;   Mar 3.35;


#67 ChessieCat

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Posted 07 April 2016 - 02:00 AM

I've just found a post in someone's topic by Brassmonkey which contained this explanation:

 

"These drugs work by making physical changes to the nerve endings referred to as "down regulating".  In general the first 5mg affect about 60% of a persons nerve ending while 10mgs affect about 80% .  Increase the dose to 20mg and only 85% are affected. So a lot of changes happen with the first 5mgs."

 

I hope that helps to explain it.


Podcasts:    Let's Talk Withdrawal

 

Antidepressants:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft; Cipramil CTed (very sick for 2.5 wks soon after)

Pristiq:  50mg mid 2012, 100mg beg 2014 (mild Serotonin Toxicity)     Current:  Pristiq 25mg (from 21 April 2017)

 

Tapering history & graph

My website - includes my brief history + links to videos & information on the web

 

I've still got a way to go ... but I've already come a long way!!!

 

PLEASE NOTE:  I am not a medical professional.


#68 grandmaD

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Posted 09 April 2016 - 12:50 AM

The fact that it affects the nerve endings helps explain a lot of things.  What I have had in the past and am experiencing worse now, is an itchy, prickling sensation which drives me crazy.  It is like someone touching me with stinging nettles in one place, then  in another place, and so on and I figured this had to be nerve ending sensations.


1995                20mg Aropax/Paxil for pain.  2000-2004 - Years of tapering and up-dosing (fast) (resultant suffering)

2004-2007       Daily 20mg

2008                Switching to Endep, Lexapro and then Esipram (hell!)

2009                20mg Aropax.  Tried skipping doses for a year (more hell!)

                        2010                10mg.  10% taper.  Lasted 4 months. Crashed again

2011                5% taper. 9mg-7mg (hell got even worse!)

2012                2.5% taper.  6.6mg – 5.6mg (worser still & unbearable)

2013                5% taper.  Big mistake.  5.5mg – 4.6mg  (even worserer)

2014                2.5% taper.  4.9mg – 4.5mg (worst year ever for w/d by far, plus gall surgery-developed arrythmia

2015                2.5% taper.  4.4mg - 4.0mg (gall surgery/anaesthetic continued to make things even worse)

2016                2.5% taper.  3.9mg  Feb 3.8   Mar 3.7  May 3.6   Jul 3.5 (finally imp. from gall surgery)

2017                2.5% taper.  Jan 3.4;   Mar 3.35;


#69 bubbles

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Posted 19 April 2016 - 12:06 AM

I tabulated some of the data from one of the graphs. I took the first sertraline graph and came up with this. It's incomplete - I didn't plot it all. :) This is VERY rough - I enlarged the graph on my screen and held up envelopes to the screen to try to work it out. To do that I'd print it out large and do some careful measuring. I started at 75mg because I was on that dose for the longest time. :) The next point is 50mg, just because. :)

 

75mg     85%

50mg     82%

45mg     80%

40mg     78%

35mg     77%

30mg     75%

25mg     70%

20mg     67%

15mg     60%

10mg     54%

5mg       36%

0mg       0%

 

Specifically - look at what happens at about the 12.5mg mark, which is half of a 25mg tablet (being the lowest dose available in the US, I think?) - it's going to be a bit under 60% - let's call it 57%.

 

I'd think that there wouldn't be many people on less than, say, 25mg or 12.5mg (being half a 25mg tablet) so I imagine that would be the smallest dose for which they'd really have data. So the curve must be extrapolated and calculated? I wonder what is really happening down at the small end of things.

 

Anyway, just musing. It certainly does suggest that the drop from 5mg to 0mg might be more problematic than the drop from 75mg to 50mg. 


My thread here at AS: http://survivinganti...-bubbles/page-3

2001 Hashimotos diagnosis

2005 St John's Wort

2006 Lexapro 20mg

2 unsuccessful attempts to discontinue

Discontinued successfully over 5 or so months in early 2012

January 2013 started sertraline, over time worked way up to 100mg

July 2014 dropped from 100mg to 75mg, held for several months

January 2015 started to taper to 50mg over several months, held for several months

February 2016 at 35mg

6 March 2016 at 33 mg

(also takes Armour Thyroid plus a small dose T4)


#70 Rufous

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Posted 21 May 2016 - 07:48 PM

As a "been there" newcomer my comment/share is that my doc, in advising me how to come off an ill-fated dose of Lamictal, recommended 100-75-50-25-0mg per week withdrawal.  Ha.  the first step was easy.  The 2nd step, toward the end of the 1st day, was as if the systems in my body were disconnecting one by one.  So I retreated and cut way back, beginning a graduated regimen as per this site.  I was taught by the drug to go to smaller & smaller amounts on the way down. Which to me is empirical, experiential verification of the model.  Am currently down to 18.75mg and holding.


After 25 yrs w/attivan, my shrink said you gotta ease off that stuff, it will fry your brain - plus the govt is giving me a bad time.  So off we go, moving from 2 tabs to <1, when the bottom fell out.  Since then it has been a slow laborious slog, and not until I found this site did I find it possible to minimize dose & the misery.  In the middle of all that my neurologist put me on 100mg lamotrigine which kept me awake, and off we go on it.  Both docs say then have not seen anything like my case in their practise.  Yet they are supportive which is thankful.  As of 21 May 2016 amcurrently down to 1.75mg diazepam (switched from attivan) and 18.75mg lamotrigine.

 


#71 woof

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Posted 22 May 2016 - 08:12 AM

I beleive this article and the the incredible graphs within it, explecitly depict what ADs do at various doses. IMO reading this article should become the standard of care and a mandatory part of informed consent for health care providers and their patients when taking, tapering or considering taking ADs. 

 

Prior to reading this article I was totally unaware of the the exponential fashion in which these drugs work at doses which are much, much lower than those which are typically prescribed.

 

Please do not do this, but this is in fact what happened to me. I was taking 40mg Cymbalta/day for four years.  One day I decided to cut my dose in half and take only 20mg Cymbalta/day; this was without any taper whatsoever.  I never experienced any wd symptoms at all. 

 

Six years later, I thought that could simply do this again (same dosage right :blink: ) so I "cold turkey" stopped the 20mg Cymbalta/day, just as I had done in the past, but this time I crashed and burned BAD! :o : 10/10 severe: insomnia, anxiety, restlessness/akathesia, Tinnitus.    

 

So, slow and low is good.


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/

 

 


#72 Altostrata

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Posted 12 June 2016 - 04:04 PM

Our esteemed scallywag has made a chart showing what skipping doses does to your blood level of Cymbalta, for example:
 

I'm seeing a fair amount of discussion with newcomers about skipping doses.  I've created a spreadsheet that shows the % concentration decay, comparing daily dose, alternate day dosing and skipping 2 days. This chart is for Cymbalta (duloxetine) or a drug that has a 12-hour half-life.
 
The chart is in a spreadsheet (.xlsx).  I'm going to refine it, maybe showing every 12 hours instead of every 24 and setting it up so that any half-life can be "inputted." Then I'll attach it to another post.
 
The blue line is taking daily doses; green is every other day dosing; red is every 2 days.

 

scallywag_skipping_doses.jpg
 
http://www.mediafire...pping_doses.jpg


Edited by Altostrata, 13 June 2016 - 12:53 PM.
updated link

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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