Altostrata

About reinstating and stabilizing to reduce withdrawal symptoms

71 posts in this topic

VJ, didn't you take a big dose instead of the low dose we suggested?

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Yes alto I did- I jumped up to 20- I did what my doc told me to do- mistake - huge mistake

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I understand you were following your doctor's orders. The reason we suggest a very low dose as reinstatement is to avoid adverse effects from a powerful dose, which can delay stabilization or make someone worse.

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I'm on day 6 of Lexapro reinstatement and actually felt OK for a couple hours minus the exhaustion from insomnia. I hope to build on that amount of time tomorrow.

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Hey guys I always re-read this thread during a wave. And I am in a bad one. Bedridden for 2 days and counting due to a myriad of intense symptoms. I usually read the forum and talk myself out of reinstating. My gut says no but I dont know foresure. I am 17 months off and although Ive seen some improvements, I am not functional yet. Could a 1mg reinstatement make me much worse? I guess in tough times I need to know that by not reinstating im doing the best thing for my recovery or am I making a mistake by not trying reinstatement? Any advice is appreciated. Thanks

 

Mort

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Mort, For me updosining made me sooo much worse and it took at least a month to stabilize somewhat. I only updosed from 4mg to 5mg and felt like my brain was exploding...  I developed new symptoms like andehonia and insomnia and akathisia. It was really traumatising. I think that in your case when you have been off meds for so long reinstatement would be really like russian roulette.

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Prior to about 4 days, there are variations of the drug level in your bloodstream, your body does not get the full dose consistently 24 hours a day until around the 4th day. You may still feel effects of the drug, though.

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Alto, have you gotten your emotions back after your reinstatement? You wrote in some thread that you were on Paxil first few years and then you were off for an year and then you started Paxil again and on the second time on Paxil it blunted your emotions. I wanted to ask this bc you have been off Paxil after you CT'ed for so long and bc so so many experience anhedonia after reinstatement. 

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Just throwing in my experience...

 

- re-instated Paxil ~15mg approx FIVE months after severe withdrawal started (itself taking 6 weeks after my last pill). Sounds like I was lucky considering this is on the far end of successful reinstatement delays.

 

- reinstatement quickly cleared up the withdrawal insanity (panic attacks, cognitive dysfunction/memory loss, de-realization, worst OCD of my life)

 

- unfortunately, reinstatement also brought a *fierce* anhedonia, apathy, and loss of motivation - The likes of which I hadn't experienced in ten years of 60mg+ Paxil. This hasn't gone away yet, I'm on 8mg and still tapering slowly. In some ways, this is much worse than withdrawal since I could still enjoy music, sex, sunshine, socializing etc during withdrawal.

 

- muscle pain, digestive issues, general spaciness still lingered after reinstatement.

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Alto, have you gotten your emotions back after your reinstatement? You wrote in some thread that you were on Paxil first few years and then you were off for an year and then you started Paxil again and on the second time on Paxil it blunted your emotions. I wanted to ask this bc you have been off Paxil after you CT'ed for so long and bc so so many experience anhedonia after reinstatement.

This was my exact experience.. Never had anhedonia until reinstatement. Didn't realize this was a common thing?!

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Alto, have you gotten your emotions back after your reinstatement? You wrote in some thread that you were on Paxil first few years and then you were off for an year and then you started Paxil again and on the second time on Paxil it blunted your emotions. I wanted to ask this bc you have been off Paxil after you CT'ed for so long and bc so so many experience anhedonia after reinstatement.

 

This is incorrect. I never reinstated Paxil myself. After going off Paxil in October 2004, I suffered acute withdrawal syndrome for about 11 months and post-acute withdrawal syndrome for another 10 years. My emotions gradually came back in the last half of that period.

 

Please take discussions of drug-induced symptoms to such topics as these:

 

Did antidepressant reinstatement work for you?

 

Anhedonia, apathy, demotivation, emotional numbness

 

Disconnect between interest and action/motivation

 

Derealization or Depersonalization

 

Personality changes during withdrawal, who's had them?

 

"Change the channel" -- dealing with cognitive symptoms...

 

"Is it always going to be like this?"

 

What does healing from withdrawal syndrome feel like?

 

Inactivity may make sympathetic nervous system hypersensitive...

 

Non-drug techniques to cope with emotional symptoms

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YMMV, but I reinstated at 4/5 months to keep my job. And I did it in a terrible way (tried all kinds of other drugs before going back on the original) and it "worked" for me. 90% of the symptoms went away or were greatly improved, saved for adding fatigue and anhedonia.

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Reinstatements have been a lifesaver for me. I've had to updose a bit at several points in my taper when my body couldn't handle my previous taper schedule.

 

The relief I feel immediately after reinstating (generally the day after) is the only thing that gives me hope to keep going.

 

I've read at benzo forums that one should never reinstate repeatedly because it can cause kindling. I understand how that could happen, and every reinstatement carries risk, but I just couldn't remain minimally functional without reinstating. Neither would I been able to keep cutting, as unstable as I was for weeks and months.

 

So in MY case, reinstatements helped me stabilize, continue tapering, and function.

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Questions:

 

Does this advice apply the same way to someone who only tapered part way and is still on the med but considering reinstating to the original dose? Especially the advice about being sensitized to the drug.

 

Does the reinstatement advice apply to all psych meds, not just antidepressants? (In my case, Seroquel.)

 

Is it really possible to be symptom-free?

 

Thanks.

 

MN

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If you are tapering and get withdrawal symptoms that don't go away in a few days, a small updose might help. You may not need to go back all the way to the original dosage to quell withdrawal symptoms.

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"Is it really possible to be symptom-free?"

 

The idea of reinstatement and updosing isn't to become free of symptoms but to get the withdrawal symptoms to a bearable level.

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This is cool, very helpful. I was off for a long time, several years. I cold-turkeyed for the most part, and I was on a heavy-duty "cocktail." I believe my brain was damaged by taking the drugs, not from withdrawal. Stopping them any way I could saved my life.

 

I had none of the "brain zaps" people describe. Insomnia resulted from decades on drugs. After five years of barely sleeping at all, I finally decided I couldn't stand constant exhaustion. My mood was not affected, but I tended to be short-tempered because I could barely stay awake. I recall feeling that I would fall asleep while walking and doing ordinary tasks. I also dropped things that were in my hands due to mini-sleeps.

 

I obtained some Seroquel without a prescription (not quite legally) and started back at the lowest possible dose. It was like a miracle. My goal is to get off, but really, I'm so thrilled to sleep that I am less worried about the drug damage from such a low dose than I am about the devastating consequences of sleep deprivation. I think the only way I can taper would be to grind it up (it isn't XR) and dissolve it in water, then drink, and do a very very very slow taper even from this mini-dose.

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If a low-dose reinstatement doesn't seem to be helping after a couple of weeks, is it necessary to taper or can you stop immediately?

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Some (like me) may have never have had any problems with Cymbalta... until I Ct'd off. 

 

So for me, being free of symptoms, was my goal and I was hopeful that reinstatement would do so - It was just going to take longer than I had expected, so I prematurely began to taper after 4 months of a full dose reinstatement.

 

It's now been 6 weeks since my full updose to 20mg/d Cymbalta and this is the best I've felt in over a year. 

 

My only sx now is 2-3/10 tinnitus.

 

I hope this helps,

Woof out

 

 

How long should you give reinstatement?

  • 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.

 

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Sorry for the delay in answering Mellie - I wanted to check with the other mods. 

 

If a low-dose reinstatement doesn't seem to be helping after a couple of weeks, is it necessary to taper or can you stop immediately?

 

It would pay to taper, but it can be done at a faster rate than the usual 10% monthly (unless w/d symptoms indicate otherwise).  You could try reducing by 25%, waiting a week and assessing how you are feeling.  If all is good, try another 25% and so on.  If symptoms increase, that is a clear sign to slow the taper. 

 

Of course if you are already suffering from previous drug changes, that is another reason to taper carefully.  A sudden stop can make things much worse. 

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I'm curious if anyone knows if reinstatement typically helps or typically makes a person worse.

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My experience was a good one with reinstatement of an AD.

 

I had done a too fast taper as per my GP and had some really awful debilitating symptoms that made me lose the use of my legs for a while.

I had got down to 10mgs of Citalopram before WD hit and went up to 20mgs and then my full dose of 30mgs before I was fully aquainted with SA.

 

I got some relief from the symptoms straight away and after a few months was feeling a lot better. I still had ups and downs though and held for a year before starting a taper.

 

I tapered successfully for a year until Dec 2016 when something went wrong and I am now struggling again and trying to stabilise.

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I'm curious if anyone knows if reinstatement typically helps or typically makes a person worse.

 

I can only speak for myself, I jumped off at 2.5 and crashed about 5 mos later, and successfully  reinstated.

And by successful, I mean it pulled me out of the worst of things, when I had over 40 symptoms, all severe, for weeks.

 

I think I'd have been a LOT better off if I'd done a proper taper, for me, the reinstatement helped tremendously

 

I also reinstated at an extremely low dose, so that may have something to do with it.

I have been staying more or less stable now at well under 1mg of liquid lexapro

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I just wanted to check back in with an update. I CT'd from 20 mg Prozac in November 2015, then started having the horrible hyper-alerting symptoms in May 2016 (insomnia, anxiety, agitation, dread, depersonalization). I whiteknuckled my way through nearly 8 months of these symptoms, with windows and waves. However, I got really bad after I was diagnosed and had surgery for breast cancer in November 2016. By December, I was in a very dark, dangerous place. 

 

I couldn't reinstate Prozac, because it interferes with an important cancer drug, tamoxifen, that I'll be taking for the next 5-10 years. So I tried a small dose of Lexapro: 2.5 mg. This was a little more than 13 months after my CT. After two weeks, I stopped, because I feared it was making my anxiety and insomnia worse. But since then, I've figured out it was the fluoroquinolone antibiotic I was taking that was making things worse (I was on it for a month).

 

I went back on 2.5 mg of Lexapro on January 16. Since, then my symptoms have gotten much better. Suicidal ideation, dread, and depersonalization are gone. Anxiety is much better. And sleep has improved. This despite the huge stress of dealing with cancer and also having gone on another antibiotic for two weeks (azithromycin -- which also caused increasing anxiety and agitation while I was on it).

 

So reinstatement worked for me -- even with a different medication after a long SSRI-free gap. I don't plan on upping my dose. I just want to stabilize while I get through my medical crisis, and so far it is definitely helping.

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So good to hear that RI lex worked for you Mellie!

This confirmed my guess about a greater chance of success in RI a different ssri as opposed to RI the same drug. For reasons we don't know, RI the same drug has greater probability of getting a reaction. I know it can't be generalized for 100% assurance, but many people changed ssri by their doctors when the old one is poopout, and many got severe reaction going back to their original ssri even at significantly smaller dose.

 

It's possible that even different SSirs block the same receptors, the molecular binding mechanism can be different so a different ssri can still work while the old one is fully exhausted.

 

Of course, this is nothing proved, only statistics from the uncontrolled random but massive incidences.

 

Don't know if agreeable by others, in case this is true, it can help with a less risky RI for those CTed and those got severe reaction being forced to CT.

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That's good to hear, Mellie.

 

LexAnger, I don't believe it's true that a different SSRI is more effective as a reinstatement. There's so much variability among people, it's impossible to predict exactly what will happen, so we look to the history as a guide. Generally, it's best to reinstate a drug that was well tolerated before rather than to introduce a new drug that may cause adverse reactions, which will complicate the situation greatly.

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Alto, I believe you know the best. Only after reading so many who got severe reaction after RI the original drug, myself included by one increased dose, and many people on SSirs switching From one to another for decades not getting reactions, I can't help but thinking that something mysterious in the play of the RI. You are absolutely right about the incredible variabilities not just across individuals but also within. I feel it will never be clear even with so called controlled studies, as the whole thing is super dynamic moment by moment beyond the most complicated mathematic modeling.

 

Like all statistics, there will be always a probably of error when dealing with individual cases. So a guessing game with higher chances is all we can do.

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With regards to the 2 month window period suggested, where there's a chance reinstatement might not work, is this 2 months after discontinuation of a drug or 2 months after the onset of WD symptoms?

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I'm fairly sure that it is 2 months from quitting the drug.

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What is considered an immediate bad reaction upon reinstatement?

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HI,

 

My reinstatement experience:

 

Tapered off 40mg Celexa over 3 months. Over the next 3 months, felt increasing symptoms of irritability, self-consciousness, vulnerability to stress, low mood and anxiety, intrusive thoughts, emptiness and hopelessness. Was taking small amounts of Valium and Oxazepam for anxiety.

 

On reinstatement, anxiety went through the roof, extreme nausea and vomiting, waking really early with cortisol/ adrenalin spikes, felt desperate, didn't think meds would work again. Taking Lorazepam, valium, oxazepam to get though the day and sleep. Panic attacks.

Went up slowly 10mg for 2 weeks, 20mg for 1 week, 30mg for 3 1/2 weeks. Lost 4kg. Vomited a lot in the morning.

 

After 7 weeks, clouds parted and the sun came out and I felt safe again. 

 

SO: 3 months taper, 3 months off, nearly 2 months of HELL to get well again on ADs

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An immediate bad reaction would be a sudden worsening of any of the symptoms associated with withdrawal.  Tikki Tikki above has given a good example.  It might happen any time in those first 4 or so days. 

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If I were Tikki, I might have started at a much lower dose of Celexa. But good to hear all has settled now.

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I did a quick taper off 20mg cipralex in 2 months that I had used for six years. Made it through 2 months off the drugs, not worth it I wish I had found this site prior to my taper. I've never felt so bad in my life the last two months. I'm a week into a small dose reinstatement already feel a bit better. Plus the fact I'm out of work it was a bad time go through withdrawal. Make sure you have time and a support system around you before you taper. I thank everyone on this site for Sharing there experiences. This battle with ssri is a tough one. I need to stabilize for awhile and regroup. Good luck

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I am on day 5 of taking citralopam 20mg and I am already experiencing the negative side effects; feeling lethargy on waking and having to drag myself out of bed, less energy, general feeling of nothing! It has reminded me of what I was like on Prozac up to November last year. However, it is starting to ease my anxiety and depression. I felt I couldn't go on with the level of anxiety and depression that I was suffering. I wish I didn't have to take the AD. Physicly i had never felt better while off AD. I hope when I have some stability I will be able to try again and be free of these symptoms.

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