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About reinstating and stabilizing to reduce withdrawal symptoms


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#1 Altostrata

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Posted 08 October 2012 - 03:17 PM

ADMIN NOTE This topic is a general discussion of the principle of reinstatement. For case-by-case consideration of what YOU should do, please put your questions in an Introductions topic.
 
Do not put those questions in this topic, because detailed discussion of YOUR particular circumstances will take it off track and make this topic difficult for others to follow. The moderators will move any questions about YOUR particular case to the Introductions forum. Thank you.
 
Also see

After Reinstating or Updosing, How Long To Stabilize?

Stabilizing after a reduction -- what does that mean?
 

 

Don't suddenly go off medication assuming that reinstatement is a safety net. This is one of the reasons we advocate gradual tapering to minimize withdrawal symptoms. Once the nervous system is destabilized by withdrawal, all bets are off.

Medicine wants to believe the acute phase of withdrawal lasts only a few weeks. From what people have posted on the Web, it can last many months.

The inserts in all the newer antidepressants and many other psychiatric drugs advise reinstatement of the medication if withdrawal symptoms appear. This is all medicine knows about how to treat withdrawal.

What is known about reinstatement
from my reading and from patient experience as posted on online support sites:

  • According to medical knowledge, reinstatement is the only way to alleviate withdrawal symptoms.
  • Reinstatement is best done immediately upon appearance of withdrawal symptoms. The more time that passes, the less likely it is to work.
  • The length of this window of opportunity varies according to the individual. Sometimes people can reinstate successfully months after quitting. Others cannot.
  • Some find a partial dose will relieve withdrawal symptoms. If, for example, you were taking 20mg Paxil and quit rapidly only a few days ago, 5mg or 10mg may be enough. Others find they need a higher dose.
  • Start low to see what you need. You can always increase if necessary. If you've been off the drug for a month or more, many people can find relief from antidepressant withdrawal symptoms by reinstating as little as 1mg-5mg.

Additional reasons to reinstate only a partial dose
Reinstating at a low dose reduces the risk of severe adverse reactions in case reinstatement does not work.

  • Experiencing withdrawal may have sensitized you to drugs and a larger dose will cause an adverse reaction.
  • These drugs are vastly more powerful than they need to be and you want to be taking only the lowest EFFECTIVE dose.
  • Your receptors may have adjusted somewhat (upregulated) during the time you had withdrawal symptoms.
  • If you can stabilize on a lower dose, you have less to taper when you finally do go off.
  • If you had adverse reactions while you were taking the drug, a low dose may not trigger the adverse reactions but still reduce withdrawal symptoms. Adverse reactions tend to be dosage-related: The higher the dose, the worse the reaction.
  • You can always adjust the dosage upward if you find you need to.

How long should you give reinstatement?

  • It takes at least 4 days for your body to fully register the addition of a neuroactive drug. Unless you have an immediate bad reaction, observe your symptom pattern for about a week to see if the reinstatement is helping. If you have an immediate bad reaction, reduce or stop taking the drug.
  • After reinstatement, the amount of time needed to alleviate withdrawal symptoms (stabilizing) varies according to the individual. Relief can be felt immediately, after some weeks, or after some months.
  • Once you feel withdrawal symptoms are reduced after reinstatement, give your nervous system time to stabilize before attempting dosage reduction. Think in terms of months, not days.
  • Be patient after you reinstate. Reinstatement may not immediately eliminate all withdrawal symptoms. You may still experience waves of symptoms, which usually lessen as time goes on. Do not attempt to taper again until you feel symptom-free, or at least until your withdrawal symptoms are mild and tolerable.
  • The dose needed for effective reinstatement varies according to the individual.

When to discontinue reinstatement
If, upon reinstatement, you very soon feel worse, most likely you are sensitized to the drug and need to take a smaller dosage or, possibly, none at all.

  • Sometimes reinstatement does not work. The nervous system has taken such a hard hit from withdrawal, it's destabilized beyond whatever effect the drug might have had.
  • Sometimes reinstatement not only does not work, it causes an adverse reaction from a nervous system sensitized by withdrawal.
  • If you have an immediate bad reaction, reduce or stop taking the drug.

Reinstate at what dosage?
Sometimes reinstatement not only doesn't work but makes symptoms worse. That is why we often suggest very, very low doses -- to reduce this risk. Higher doses can go wrong in much bigger ways. A very low dose is a way to explore the option with less risk.
 
The dosage is always going to be a guess. Here are some factors that might influence the dosage of reinstatement:

  • How the person quit the drug and how long he or she's been off it. If you've just cold-turkeyed 20mg Celexa a few days ago, you might reinstate at closer to your original dosage, such as 10mg. (It may not be necessary to go back to 20mg, standard dosages tend to be overly powerful.)
  • If you've had withdrawal symptoms for a month or more, it's likely your system is somewhat sensitized to drugs. You might wish to try reinstating at a lower dosage, such as 2mg-5mg (if you had been taking 20mg Celexa).
  • Your present condition. If you have symptoms of hyper-reactivity, alerting (anxiety, panic, sleeplessness), you may be too sensitive for reinstatement. If you want to try it anyway, you might wish to try reinstating at a very low dosage, such as 1mg (if you had been taking 20mg Celexa).
  • How long you've been off the drug. If you've been off the drug for many months, reinstatement is less likely to work. If you want to try it anyway, you might wish to try reinstating at a very low dosage, such as 1mg (if you had been taking 20mg Celexa).
  • Other drugs you're taking. Be very careful adding a drug to other drugs. Use the Drug Interactions Checker before even considering this. (Your symptoms may be due to drug-drug interactions.)

None of the above are hard-and-fast rules. There are reports of people with prolonged post-withdrawal syndrome who did better taking a drug at full dosage 2 years later. If you want to do this, please consult a doctor, we cannot advise you on it.
 
About benzo reinstatement http://www.benzosupp...instatement.htm


Edited by Altostrata, 29 October 2016 - 10:27 AM.
updated

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

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#2 Altostrata

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Posted 07 March 2013 - 12:16 PM

Also see this topic What does stabilizing mean?

What's been your experience with reinstatement and stabilizing? Please post in this topic.
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.

#3 cmusic

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Posted 07 March 2013 - 02:22 PM

About six weeks ago I went off Prozac cold turkey. My doctor assured me that this particular drug has a long half life and a natural taper. I had my concerns but decided to do it. One of the major decision criteria was that I was pretty much in a perpetual hell while on the meds - it's not like I was stable and could slowly chip away at it.

 

But now I am of course regretting that decision and the wisdom on this site has been proven right again. Panic and fear so intense I can barely move - stomach in a knot - GI issues, and hysterical crying, over emotionality, and depression. But what trips me up is that these things were there when I was still on the drug (albeit a little less intense and more 'cycling').

 

So after six weeks I'm considering a reinstatement. I am hoping a small dose could still be beneficial? I'm trying to figure out if I was on 30 mg, what would be the ballpark for getting back on - 5, 10?

 

Having gone cold turkey and now looking to reinstate, any advice would be helpful around dose and longevity (realizing it's not formal medical advice). Just wondering if I'm doing the right thing. Happy (well not really) to be a test subject here.


Edited by Petu, 16 January 2014 - 03:21 AM.
fixed text

Started on Zoloft in 2002
Switched to Lexapro in 2005
Switched to Prozac in 2008
Off Prozac abruptly in 2010 (a mistake) - crashed
Lexapro end of 2010 - didn't work
Effexor until 2012 - roller coaster from hell
Back to Prozac November 2012 - one last rise and fall
Quit Prozac 01/13

Reinstated Prozac 5mg 05/13
Trial of 7.5 Remeron for one month 06/13, then off

Off Lamictal 06/13

Quit benzos 06/13

 

Reduced to 4mg Prozac 8/15/13

 


#4 cmusic

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Posted 07 March 2013 - 02:27 PM

So I just read the post on stabilizing... "Most people are stable on psychotropic medications before their first taper, so there are no withdrawal symptoms. Holding helps to stabilize withdrawal symptoms that are acquired while tapering, going off CT, etc." My issue is that I haven't been stable like this for three years. The meds have stopped working and I believe I have been in some kind of withdrawal while still on meds. This the whole notion of tapering didnt make any real sense to me.

Started on Zoloft in 2002
Switched to Lexapro in 2005
Switched to Prozac in 2008
Off Prozac abruptly in 2010 (a mistake) - crashed
Lexapro end of 2010 - didn't work
Effexor until 2012 - roller coaster from hell
Back to Prozac November 2012 - one last rise and fall
Quit Prozac 01/13

Reinstated Prozac 5mg 05/13
Trial of 7.5 Remeron for one month 06/13, then off

Off Lamictal 06/13

Quit benzos 06/13

 

Reduced to 4mg Prozac 8/15/13

 


#5 tezza

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Posted 07 March 2013 - 04:59 PM

About six weeks ago I went off Prozac cold turkey. My doctor assured me that this particular drug has a long half life and a natural taper. I had my concerns but decided to do it. One of the major decision criteria was that I was pretty much in a perpetual hell while on the meds - it's not like I was stable and could slowly chip away at it.

But now I am of course regretting that decision and the wisdom on this site has been proven right again. Panic and fear so intense I can barely move - stomach in a knot - GI issues, and hysterical crying, over emotionality, and depression. But what trips me up is that these things were there when I was still on the drug (albeit a little less intense and more 'cycling').

So after six weeks I'm considering a reinstatement. I am hoping a small dose could still be beneficial? I'm trying to figure out if I was on 30 mg, what would be the ballpark for getting back on - 5, 10?

Having gone cold turkey and now looking to reinstate, any advice would be helpful around dose and longevity (realizing it's not formal medical advice). Just wondering if I'm doing the right thing. Happy (well not really) to be a test subject here.



Hi cmusic,

It's possible that a small reinstatement would still help you. I would give it a try if I were in your shoes.

As for how much and how long, Alto would give the best advice.
http://survivinganti...dal-withdrawal/

Seroquel and Mirtazipine

#6 Altostrata

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Posted 07 March 2013 - 06:09 PM

Sorry for the confusion, cmusic's question was answered in his topic http://survivinganti...2103#entry42103

If your symptoms have gotten worse, that's a sign the Prozac was doing something. A higher dose might have made you worse, but a very low dose might help the withdrawal symptoms.


Low-dose reinstatement may reduce the withdrawal symptoms experienced after quitting. These would be new symptoms different from the adverse effects of the drug while you were taking a full dose.

"Stabilizing" as we use it means reducing withdrawal symptoms. It doesn't mean resolving whatever problems you might have had before going on the drug, or returning you to a perfect state of mind or body. Sometimes reinstatement works only slightly -- at least that's better dealing with the full force of withdrawal symptoms.

And, unfortunately, sometimes it does not help at all.
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.

#7 Meimeiquest

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Posted 09 April 2013 - 01:33 PM

My little experience: Jumped off Zyprexa 12/29/12 after a few months taper (don't remember the start...no idea it would matter). Mostly was on Zyprexa 5mg, jumped off at about 0.6 mg. tried a dose of 0.2mg 4/713. Slept too much, missed a work deadline, totally sedated, screaming at my husband (I know those 2 shouldn't go together). And the nausea that I was trying to stop re-emerged at 11 a.m. But otherwise it went well :).
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

#8 dmpjhp

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Posted 14 April 2013 - 07:29 PM

My husband had strong w/d symptoms ten weeks after stopping practically cold turkey. Vertigo, brain zaps, headaches, back pain. He took four 20mg pills of his med, Lexapro over the course of two weeks. I had no knowledge of this until after the fact. He moved out after being on the SSRI for 3 months. I asked him to half the pills, so at least they would not be so strong. He agreed, and now is taking a half pill every few days, somewhat regularly. He is starting to shave the halves now and will continue to taper. He says it is relieving the symptoms, but is distant and cold toward me again, even though the dosage is lower. I realize this is not the best way to re-taper, but can it be effective?
Husband took Lexapro for supposed depression September-December 2012
Became distant after increasing to 20mg middle of September
Left home November
Went off pills cold turkey in January. Cut to 10mg for two weeks, then to 0
Went back on sporactically in April because of physical symptoms, mainly brain zaps
Off completely end of April 2013
Rollercoaster of emotions toward me for the next year
Has not had positive feelings for me since April '14, extremely hostile
Divorced me May '15

#9 Altostrata

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Posted 15 April 2013 - 10:12 AM

Your husband should be sure to take the same amount every day, at the same time every day. Reinstatement can work but skipping doses is like playing ping-pong with your brain. Not a good idea at all!!! Antidepressants can cause emotional anesthesia. As your husband lowers the dosage, or after he's off for a while, his emotions probably will return.
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.

#10 dmpjhp

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Posted 15 April 2013 - 02:12 PM

Thank you, that makes sense. Not sure he will be willing to listen now though. Has become very cold and a little hostile with the build up of medicine. Brain zaps are his worst symptom. Would it be better to just get off now and tough it out? If he keeps going this way, or begins taking them daily again, even at a low dose, Im afraid we will be headed for divorce court. He has had four full strength and four half pills (20 & 10), since mid March.
Husband took Lexapro for supposed depression September-December 2012
Became distant after increasing to 20mg middle of September
Left home November
Went off pills cold turkey in January. Cut to 10mg for two weeks, then to 0
Went back on sporactically in April because of physical symptoms, mainly brain zaps
Off completely end of April 2013
Rollercoaster of emotions toward me for the next year
Has not had positive feelings for me since April '14, extremely hostile
Divorced me May '15

#11 Altostrata

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Posted 15 April 2013 - 02:34 PM

Some people get over withdrawal symptoms such as the brain zaps, and some people get worse for a long time. We don't believe in trying to tough it out when you get severe symptoms.
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.

#12 dmpjhp

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Posted 15 April 2013 - 02:51 PM

If he will agree to switch to liquid, on what strength should he begin? Sorry to throw all this on you, but he will not go back to his doctor. Thinks he can handle it on his own. Also, he is extremely busy and stressed at work right now. Would that hinder his healing? His emotions will come back if he can get off these drugs. He has been on a major roller coaster, loving me two weeks ago and now not wanting to speak to me. Thank you so much for your help.
Husband took Lexapro for supposed depression September-December 2012
Became distant after increasing to 20mg middle of September
Left home November
Went off pills cold turkey in January. Cut to 10mg for two weeks, then to 0
Went back on sporactically in April because of physical symptoms, mainly brain zaps
Off completely end of April 2013
Rollercoaster of emotions toward me for the next year
Has not had positive feelings for me since April '14, extremely hostile
Divorced me May '15

#13 Altostrata

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Posted 15 April 2013 - 03:02 PM

Given he's skipped doses so often and already has withdrawal symptoms, he might be okay with 5mg per day. He should stay at one level for at least a couple of months and until withdrawal symptoms subside. Then he can consider tapering by very small amounts. He will need to have the discipline to use an oral syringe and measure out his doses.
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.

#14 dmpjhp

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Posted 16 April 2013 - 01:50 PM

Needless to say, he is and had always been super sensitive to any medication. Would it be beneficial for him to take Amino acids or vitamins?
Husband took Lexapro for supposed depression September-December 2012
Became distant after increasing to 20mg middle of September
Left home November
Went off pills cold turkey in January. Cut to 10mg for two weeks, then to 0
Went back on sporactically in April because of physical symptoms, mainly brain zaps
Off completely end of April 2013
Rollercoaster of emotions toward me for the next year
Has not had positive feelings for me since April '14, extremely hostile
Divorced me May '15

#15 Altostrata

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Posted 16 April 2013 - 02:33 PM

Please see our Symptoms and Self-care forum.
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.

#16 Motoxmom

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Posted 16 April 2013 - 06:28 PM

If he will agree to switch to liquid, on what strength should he begin?
Sorry to throw all this on you, but he will not go back to his doctor. Thinks he can handle it on his own.
Also, he is extremely busy and stressed at work right now. Would that hinder his healing?
His emotions will come back if he can get off these drugs. He has been on a major roller coaster, loving me two weeks ago and now not wanting to speak to me.
Thank you so much for your help.


Hi there,

Just wanted to chime in to say that withdrawl has always been hard on me and my husband. He likes to say "paxil free, don't like me" It's just because of the roller coaster of emotions we who are weaning or tapering go through. I'm sorry you've had to be on the receiving end. We who are going through that are in our own kind of hell. These damn drugs!
Been on paxil for 18 years. Have tried many attempts to wean.

Clonazepam .5 mg. per day times 21 years. Need to get off this as well at some point.

#17 Meimeiquest

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Posted 17 April 2013 - 06:06 AM

And very hard for the people who love us
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

#18 mammaP

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Posted 25 April 2013 - 12:27 PM

And very hard for the people who love us

Very hard indeed :(

**I am not a medical professional, if in doubt please consult a doctor with withdrawal knowledge.

 

See how to create a signature here http://survivingantidepressants.org/index.php?/topic/12364-please-put-your-withdrawal-history-in-your-signature/

 

Many drugs for many years, prescribed diazepam first 1973, took occasionally. 3 or 4 tricyclics  for short periods.

1993 had a breakdown leading to 10 years of drug experiments with all classes of psych drugs.

2002  effexor. 

Tapered by counting beads from March 2012 to March 2013, ending with 5 beads.

Withdrawal April 2013 . Reinstated 5 beads reduced to 4 beads May 2013

Restarted taper  Nov 2013  

OFF EFFEXOR Feb 2015    :D 

 

Also tapered atenolol and omeprazole Dec 2013 - May 2014

 

Tapering tramadol, Feb 2015 100mg , March 2015 50mg -hold- Feb2016 46mg  March 8 2016 45 April 44mg  May 11  43mg June 14 42mg

Taking fish oil, magnesium, pro biotic.

 

My story http://survivinganti...king-in/page-33

 

Lesson learned, slow down taper at lower doses. Taper no more than 10% of CURRENT dose if possible

 

Following every sunset is a brand new day


#19 Ellen042

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Posted 09 December 2013 - 05:39 PM

Sorry if I missed a thread that explains this, but why does reinstatement only work within one month of stopping or reducing the dose of a drug? What happens if it is reinstated later?  I'm curious if this explains why I developed serotonin syndrome when I took Celexa- to the point of having to stop it immediately. I had taken Celexa earlier in my life with no problems, but I wasn't on the trazodone and nortriptyline at the same time.  Either way, does reinstatement after a month just cause the drug to be ineffective, or does it make you have an adverse reaction?  Don't bother answering if you haven't the time, as I'm not facing this situation right now, and others need help.  Just thought many would have the same question, and perhaps there's a link to a article to make answering easy.  Thank you!


Ellen

___________________________________________________

insomnia, anxiety, depression- since childhood

lyme disease, dysautonomia, chiari malformation- dx 4/1997

 

nortriptyline- 75mg since childhood

clonazepam- 3mg since 4/1997

trazodone-100mg since 4/2013, now tapering

 

rotating antibiotics and antimalarials for lyme disease

midodrine- 10mg for dysautonomia

repeated skull surgeries for chiari malformation

 


#20 Meimeiquest

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Posted 09 December 2013 - 06:24 PM

I think it becomes a wild card after that. After two months even more unpredictable. Reinstating a tiny portion and titrating up if needed is more likely to be successful. But it does help some. In my "virgin" round of AD, I stopped several times for six weeks, had a stomach ache I thought was depression, and reinstated each time with immediate relief. But that was Prozac, with it's long half-life.
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

#21 Altostrata

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Posted 09 December 2013 - 07:47 PM

Here's the topic about reinstatement, Ellen. We need to think of the nervous system as dynamic. As time goes on, it adapts as well as it can to the lack of the drug on which it became dependent, and may become intolerant of that kind of interference.
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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#22 arwen

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Posted 19 March 2014 - 05:14 PM

It looks like reinstalling can work even after 3-4 months after stopping. I will see, now it is very early to be sure.
 
I stopped Paxil at the end of last November, after a slow and long tapering. I started 2 and a half years ago at 10 mg, then 20 and then going down. It worked very well until the very end, I decreased 10-25% each time, then stabilizing for weeks (it worked for me). I had symptoms, anxiety, brain zaps, tremors, but manageable. 
 
The last drop, from 1 mg to nothing was not good. At the beginning it was fine, but after 2 months I crashed, the symptoms became unbearable. The knot in the stomach was never leaving me. I was fearing an unknown catastrophe will happen any minute. 
 
I had to reinstall at 1 mg and after one week I feel much better. 1 mg is a tiny quantity, I cut the 10mg pill in 8, and then remove some, but it can make such a difference! 

July 2011 - nasty anxiety crisis (lost job, became not functional, couldn't exit the house alone)
August 2011 - started 10mg Paxil  and October 2011 - 20mg (one month on 20mg)
November 2011 - starting slowly to decrease the dose at the pace my body supported. Down to 2.5 mg in January 2013 (17.5, 15, 12.5, 10, 7.5, 5, 3.7, 2.5) - at least one month at each step. Unpleasant, but functional, got a new job almost immediately
April 2013 - stopped completely, crashed after 2 weeks, and reinstalled 2.5mg, recovered fast.
September 2013 - started decreasing again, slower, down to 1 mg in December 2013
December 2013 - free of Paxil
March 2014 - another crash, exactly 3 months after stopping, after 2 weeks of horrors, reinstalled 1 mg - feeling better after one week.
March 2014 - July 2014: going slowly down: 1mg, 0.9mg, 0.77mg, 0.64mg
end of July 2014 - Paxil free, hopefully forever this time.
.
 

#23 UnfoldingSky

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Posted 20 May 2014 - 02:01 PM

Sorry if I missed a thread that explains this, but why does reinstatement only work within one month of stopping or reducing the dose of a drug? What happens if it is reinstated later?  I'm curious if this explains why I developed serotonin syndrome when I took Celexa- to the point of having to stop it immediately. I had taken Celexa earlier in my life with no problems, but I wasn't on the trazodone and nortriptyline at the same time.  Either way, does reinstatement after a month just cause the drug to be ineffective, or does it make you have an adverse reaction?  Don't bother answering if you haven't the time, as I'm not facing this situation right now, and others need help.  Just thought many would have the same question, and perhaps there's a link to a article to make answering easy.  Thank you!

 

I had the same issue more or less.

 

I was on an SSRI, though it didn't seem to do much one way or another.  I stopped it abruptly and somehow was okay doing that.  Then months later I re-started the same drug and all of a sudden had severe problems with it. 


Partly recovered from AD withdrawal/reactions as well as issues with other psych drugs.  Also, I am not a medical professional and nothing I say is a medical opinion or meant to be medical advice, please seek a competent and trusted medical professional to consult for all medical decisions. Also due to the withdrawal/reactions I have had I may at times have cognitive problems so please keep this in mind when reading my posts (also please note, these issues are improving as I recover).

 


#24 Altostrata

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Posted 20 May 2014 - 02:28 PM

Reinstatement is more likely to work done fairly soon after stopping a drug, while the nervous system is still somewhat shaped around the drug that's been removed. The window of opportunity is not definitely a month, and probably varies from individual to individual, but but reinstatement is best done sooner rather than later.

 

This makes waiting to see if withdrawal symptoms will go away a difficult choice. If you wait, they may go away or you may miss your chance for effective reinstatement. (Medicine assumes withdrawal symptoms last only a few weeks; it's sign you're in for a longer period of recovery if your symptoms have not diminished over this amount of time.)

 

After a while after discontinuation, the nervous system changes and may no longer accept reinstatement of the drug to repair the withdrawal reaction. It's like a series of dominoes gradually falling over time. Hypersensitivity can set in making reinstatement very difficult, as the nervous system will react in strange ways to the original drug and often other drugs as well.

 

(A combination of Celexa with trazodone and nortriptyline can result in serotonin syndrome in anyone. If one's nervous system has been sensitized by withdrawal syndrome, this can cause disastrous adverse effects.)

 

This is why when someone has been off the drug for more than a month, we suggest trying a very low dose. Hypersensitization is so common with withdrawal syndrome, trying a very low dose initially reduces the risk of a severe adverse reaction. And quite frequently, a very low dose will work to reduce withdrawal symptoms.


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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#25 alexjuice

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Posted 22 May 2014 - 07:01 AM

Reinstating probably two or more animals. In cases where a person is taking 2 or more drugs, stops only ONE rapidly and destabilizes, reinstating would work better. In cases where a person rapidly removes all drugs, reinstating would be more of a crapshoot because taking any drug immobilizes the detox organs to some degree so stopping all drugs will create more problems due to toxin mobilization and this adds an extra layer of complexity which makes the reinstatement more unpredicatable.

 

In one case this is a good theorectical argument in support of coming off drugs one at a time rather than detoxing a group of meds more gradually and all at the same.


"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman


#26 Altostrata

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Posted 22 May 2014 - 10:14 AM

alex, I'm not sure what you mean by "immobilize the detox organs."

When someone quits more than one drug at once and develops severe withdrawal symptoms, it's true that reinstatement is a crapshoot, in many ways. Which drug to reinstate, should it be both drugs, and at what dosages can only be guessed.
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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#27 alexjuice

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Posted 22 May 2014 - 10:30 AM

There is evidence from Stuart Shipko that benzos immobilize the gallbladder to a degree. One part of the withdrawal syndrome of benzos is, I presume, due to a remobilization of the gallbladder once the benzos are removed after which reactive particles would be more rapidly released and these would be very damaging in the body, causing inflammation and sensitivity to sound, for instance, insomnia, and for instance and hypothetically many other symptoms. The idea is that this part of the syndrome will only kick in once the drugs are stopped entirely, I assume the antidepressants and antipsychotics all slow the liver, gallbladder or other organs to some degree by, at the least, demanding resources for their own metabolization and this causes roadblocks and results in a buildup of toxins which are released once all the drugs are removed.

 

I think one part of w/d is probably simply removing the roadblocks and allowing the organs of the body to work more effectively -- unfortunately causing an avalche of release in the 'acute' phase of the syndrome. So this part of the problem would strike only after all the drugs are removed. Removing one drug of a multi-drug regimen would not affect the terrain in this way.

 

I take this from my experience with the mold doctors who have told me repeatedly that their patients do not recover until they are able to remove the mold metabolities and this doesn't happen until the drugs are finally gone 100% at which point the mold toxins can and do come down reasonably quickly. My experience with the mycotoxin urinalysis before and after my final d/c supports this and if it is true that rapid toxin release from GB and liver occurs after d.c then I have to think all cases would be affected by toxin release to some degree.


"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman


#28 Altostrata

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Posted 22 May 2014 - 10:43 AM

I think you and other members who have co-existing conditions such as parasites, mold infection, Lyme disease, etc. have special problems that might be related to organ functioning.

But for most people, going off psychiatric drugs is more likely to cause nervous system destabilization rather than organ malfunction. I don't think the liver or gall bladder become dysfunctional and there is no issue with toxins being released -- it's a gradual, natural body function.
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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#29 alexjuice

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Posted 22 May 2014 - 11:05 AM

To some degree the nervou system remains dysfunctional for so long because of the presence of a roadblock. If I imagine a roadblock of a physical kind it makes more sense to me why recovery can take so long. I only really know for me and my case though but I think theoretically the argument is strong for some factor like this as a part of every case. Also the toxins aren't the drugs or anything to do with the drugs, necessarily. The regular toxins of everyday life back up. This should be measurable actually but it's outside the mainstream of medicine and otherwise costly.

 

The main point, in the context of this topic, is that if toxin release plays a role in this syndrome the issue would only be unleashed after all the drugs were removed. So that if a person crashes after removing one benzo and is still on, say, a Zdrug, an SSRI and an SNRI, then it's fair to think their w/d symptoms are unrelated to this mechanism because in theory the eliminative organs are still backed up.

 

This is speculation on my part. Someday I may try to solve this part of this issue myself for other people who are suffering, depending on my own outcome, because I have tons of specialized experience in this area.


"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman


#30 UnfoldingSky

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Posted 22 May 2014 - 11:28 AM


 

(A combination of Celexa with trazodone and nortriptyline can result in serotonin syndrome in anyone. If one's nervous system has been sensitized by withdrawal syndrome, this can cause disastrous adverse effects.)

 

This is why when someone has been off the drug for more than a month, we suggest trying a very low dose. Hypersensitization is so common with withdrawal syndrome, trying a very low dose initially reduces the risk of a severe adverse reaction. And quite frequently, a very low dose will work to reduce withdrawal symptoms.

 

Sorry, I guess I didn't make my situation clear.

 

I wasn't on other drugs like the person I quoted was, and I didn't have any withdrawal when I took the drug again.  My restart was for other reasons. 


Partly recovered from AD withdrawal/reactions as well as issues with other psych drugs.  Also, I am not a medical professional and nothing I say is a medical opinion or meant to be medical advice, please seek a competent and trusted medical professional to consult for all medical decisions. Also due to the withdrawal/reactions I have had I may at times have cognitive problems so please keep this in mind when reading my posts (also please note, these issues are improving as I recover).

 


#31 Altostrata

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Posted 22 May 2014 - 05:00 PM

Correct, my parenthetical comment was on Ellen's post.

 

Alex, nervous system dysfunction is undeniably a problem in withdrawal syndrome and treating withdrawal syndrome. However, I disagree with your theory that going off all psychiatric drugs unleashes toxins. There are dozens and maybe hundreds of liver enzymes. While a drug might preoccupy one or more, the others are still working. The liver has multiple avenues of detoxification, as do the other organs.

 

I  can't extrapolate from what Dr. Shipko said, perhaps you can contact him and ask him to elaborate in regards to a case such as yours, in which going off drugs seemed to make you susceptible to opportunistic infection.


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.

#32 UnfoldingSky

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Posted 22 May 2014 - 05:04 PM

Oh okay, sorry about that.


Partly recovered from AD withdrawal/reactions as well as issues with other psych drugs.  Also, I am not a medical professional and nothing I say is a medical opinion or meant to be medical advice, please seek a competent and trusted medical professional to consult for all medical decisions. Also due to the withdrawal/reactions I have had I may at times have cognitive problems so please keep this in mind when reading my posts (also please note, these issues are improving as I recover).

 


#33 augustiny

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Posted 08 July 2014 - 04:26 PM

I have a question.  I have just begun tapering and am having very mild withdraw symptoms.  I am doing a 10% taper and am feeling positive after 6 years on Citalopram and two failed attempts at coming off the drug.  My question is at what point is it advisable to updose or reinstate?  It seems to be a useful strategy at certain points of the taper but at what point should you decide to go ahead with it?   By that I mean if you are only experiencing mild withdraw symptoms which you find livable should you up dose until you feel no symptoms or is it a last resort kind of thing when you start to feel things are getting out of control?  Thanks for the clarification in advance.  


2008 Began Celexa 10 mg for anxiety

Switched to Citalopram 10 mg a few months later- no problem

2008 first cold turkey taper- terrible idea

2009 second attempt at a taper- every other day taper- bad idea

7/8/14- began 10% taper

Currently at 9mg Citalopram liquid


#34 Petunia

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Posted 08 July 2014 - 06:24 PM

Hi augustiny,

Its difficult to answer that question because every situation is different.  Reinstatement refers to going back on a drug which has been completely stopped.  Updosing can be an option after a long hold with no improvement of symptoms.  Please would you start a topic for yourself in the introductions section here:

 

http://survivinganti...ns-and-updates/

 

We will be able to find out more about you and your particular situation and offer ongoing help and support.


I'm not a doctor.  My comments are not medical advise. These are my opinions based on my own experience and what I've learned. Please discuss your situation with a medical practitioner who has knowledge of tapering and withdrawal.

 

My Introduction Thread

 

Full Drug and Withdrawal History

 

Brief Summary

Several SSRIs for 13 years starting 1997 (for mild to moderate partly situational anxiety)

Xanax PRN

Various other drugs over the years for side effects

2 month 'taper' off Lexapro 2010

Short acute withdrawal, followed by 2 -3 months of improvement then delayed protracted withdrawal

DX ADHD followed by several years of stimulants and other drugs trying to manage increasing symptoms

Failed reinstatement of Lexapro and trial of Prozac (became suicidal)

May 2013 Found SA, learned about withdrawal, stopped taking drugs...healing begins.

Protracted withdrawal, with a very sensitized nervous system, slowly recovering as time passes animal25.gif

 

Supplements which seem to help:  High doses of Vitamin C, Magnesium, Garlic and Ginger.  Taurine, Vit D3, L-Theanine and Inositol. I'm one of the rare people who react badly to fish oil.

 

June 2016 - Started daily juicing, mostly vegetables and lots of greens.

 

VIDEO: Where did the chemical imbalance theory come from?



VIDEO: How are psychiatric diagnoses made?



VIDEO: Why do psychiatric drugs have withdrawal syndromes?



VIDEO: Can psychiatric drugs cause long-lasting negative effects?

VIDEO: Dr. Claire Weekes

 

 

 


#35 Rhiannon

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Posted 10 July 2014 - 03:35 PM

I have a question.  I have just begun tapering and am having very mild withdraw symptoms.  I am doing a 10% taper and am feeling positive after 6 years on Citalopram and two failed attempts at coming off the drug.  My question is at what point is it advisable to updose or reinstate?  It seems to be a useful strategy at certain points of the taper but at what point should you decide to go ahead with it?   By that I mean if you are only experiencing mild withdraw symptoms which you find livable should you up dose until you feel no symptoms or is it a last resort kind of thing when you start to feel things are getting out of control?  Thanks for the clarification in advance.  

 

I agree with Petu it kind of depends on your history. As you taper you will become more familiar with how the pattern of withdrawal plays out for you and what you can handle.

 

Personally I never expect to have no symptoms of withdrawal at all, I always get some when I make cuts, and when they're mild and tolerable and I can still function I just hold until they go mostly away.

 

So my choice is usually not to updose unless it's obvious that I have cut too much, too fast and my symptoms are not what I consider tolerable for me. So it's more what you describe as a last resort when symptoms are getting out of control. Like I say, you'll figure out for yourself what that point is for you. 

 

Please do consider starting a topic for yourself in Introductions and Updates.


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.


#36 arwen

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Posted 12 July 2014 - 05:38 AM

In my experience, each time I decrease the dose, I have some symptoms. The decision to updose or reinstate depends entirely on the severity of the symptoms. Brain zaps, tinnitus, lighthead, uncomfortable in my own skin, waking up trembling, all this I can bear. But when the dizziness doesn't allow me to go to work, the fear is so extreme, I don't want to exit the house, I am continuously tense or crying, then I know I did it too fast, and I have to go back to the last dose.


July 2011 - nasty anxiety crisis (lost job, became not functional, couldn't exit the house alone)
August 2011 - started 10mg Paxil  and October 2011 - 20mg (one month on 20mg)
November 2011 - starting slowly to decrease the dose at the pace my body supported. Down to 2.5 mg in January 2013 (17.5, 15, 12.5, 10, 7.5, 5, 3.7, 2.5) - at least one month at each step. Unpleasant, but functional, got a new job almost immediately
April 2013 - stopped completely, crashed after 2 weeks, and reinstalled 2.5mg, recovered fast.
September 2013 - started decreasing again, slower, down to 1 mg in December 2013
December 2013 - free of Paxil
March 2014 - another crash, exactly 3 months after stopping, after 2 weeks of horrors, reinstalled 1 mg - feeling better after one week.
March 2014 - July 2014: going slowly down: 1mg, 0.9mg, 0.77mg, 0.64mg
end of July 2014 - Paxil free, hopefully forever this time.
.