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Rhiannon

Taper more than one drug at a time?

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Rhiannon

ADMIN NOTE:

This topic is about a very subtle approach to tapering.  It is important to read the WHOLE TOPIC if you are considering this approach, as it details why it might work for some and not for others.  It also depicts subtle shifts in thinking by the writers as their experience has increased.    


 

[Original Post]

I can't remember how much I've said about why I think the "one drug at a time" paradigm is not necessarily as sound as we think.

 

For one thing, it's NEVER EVER been tested. There is no actual scientific evidence that it's easier and better for the brain to pull out one drug--from the synergistic combination that it has adapted to as a whole--forcing it to remodel itself and adapt to a completely new chemistry; then do that again, removing another drug, creating ANOTHER completely new system of chemistry; then another, then another... If this had been tested, that would be one thing, but I think it's really based on the pre-neuroplasticity paradigm. And there are NO studies done on this.

 

All these psych drugs affect multiple neurotransmitter systems.. (And we don't even really understand neurotransmitter systems and their interactions very well, so we mostly have no clue what they're actually doing.) They also affect neurosteroids and other hormones. They affect our bodies in many ways. So even a single drug is having multiple effects.

 

When you have multiple drugs, they aren't just sitting there separately doing their things. It's not like, this drug is doing this over here, and that drug is doing that over there. They're interacting. They are affecting multiple systems and creating feedback loops. They create an entire synergistic chemistry. And it's THIS chemistry--as if it were one gigantic complex drug--that the brain adapts itself to. Not lots of little separate discrete units of chemistry. Nothing is separate and discrete in the body, and nowhere is this more true than in the brain.

 

So they're interacting and networking, and the brain/CNS/body has to adapt to the entire interactive system.

 

So whatever neuroplastic changes the brain makes--and I think we agree that the brain does change, chemically, cellular-ly, in many ways, in an attempt to regain homeostasis in face of the disruption caused by these meds--however it remodels itself around the drugs, it's remodeling itself around the entire system of drugs, not just one here separate from one over there.

 

So for me, it makes just as much sense to reduce the entire synergistic blend of drugs together, as to remove one at a time.

 

It would be one thing if these approaches had actually been tried and tested. But they haven't been. "One at a time" has just been accepted as conventional wisdom, like so many things in medicine; people say it because other people say it, who say it because other people say it, I think. Based on, I think, faulty logic left over from before we began to understand the actual complexity of brain chemistry and neuroplastic physiology.

 

And based on, I think, the fact that a lot of doctors--probably the majority--are still not really seeing the obvious fact that these drugs cause concrete brain changes as the brain attempts to reestablish homeostasis. So it's not like the drug just affects you while you take it. That's why they are such idiots about withdrawal, because they are thinking of these drugs as being like aspirin, not recognizing how powerfully they force our brains to remodel themselves.

 

I do think the primary advantage to removing one drug at a time--if you do it slowly and wait a long time before starting to remove another--is that you know that if you're going too fast and your symptoms are getting worse, you only have one drug to account for that so you don't have to try to figure out which one you've been removing too fast. (Well, frankly, I actually think the primary advantage is that it's easier and less scary for the doctor if he or she is trying to help manage your withdrawal. But doing things just because it's easier for the doctor leads to absurdities like women giving birth lying on their backs, too.)

 

However, this has in actual practical fact not turned out to be much of an issue for me. As it turns out, I know which one I've tapered most aggressively, and regardless, when I begin to have an acceleration in symptoms, I hold ALL of them until I stabilize, so it doesn't really matter.

 

I just can't believe that my success so far is a fluke, although of course it could be. In my case it doesn't matter. I've seen enough of the thinking of mainstream psychiatry to know there's not a lot of actual critical rational thought happening there. (Like, giving antipsychotics to a two-year-old? how hard is it to figure out what a bad idea THAT is?) I trust my own thinking more.

 

So that's my long story about that one.

 

And it's working great for me so far. If it stops working, I'll change it at that time.

 

(I'm tapering five meds at a time, very very slowly. I'll get a sig going here with the names and quantities.)

Edited by KarenB

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Punarbhava

Excellent Post Rhi!

 

 

I tend to agree with all that you have presented.

 

 

I have a few other thoughts I could add but I believe they may be too controversial so I will refrain from doing so.

 

BTW, the thoughts do not challenge anything you have written. Rather, they challenge the beliefs regarding recovery time lines once one is off the drug, regardless of the method one chooses and despite the number of drugs.

 

 

In any case, I believe you are doing the right thing for yourself and I tend to agree with your logic and reasoning, however your method would likely be too complex and confusing for most people to navigate through.

 

Hence, this is why the "one drug at a time method" seems more reasonable and practical to promote.

 

 

You know what I mean? Many people have difficulty WD from one drug at a time.

 

As Alto stated, you appear to be very in tune, observant, not to mention, very intelligent educated and aware, perhaps even very intuitive and thus, are able to differentiate and distinguish what is going on and when and thus, how to control the whole process.

 

Oh, I'm having great difficulty forming my thoughts and it's time to get off-line. Hope I've articulated my thoughts clearly enough. Besides there's a thunderstorm rolling in and I don't have time to review what I've written. (lol)

 

 

Continued Healing and Full Recovery to You!

 

 

Punar

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Altostrata

....

I do think the primary advantage to removing one drug at a time--if you do it slowly and wait a long time before starting to remove another--is that you know that if you're going too fast and your symptoms are getting worse, you only have one drug to account for that so you don't have to try to figure out which one you've been removing too fast. (Well, frankly, I actually think the primary advantage is that it's easier and less scary for the doctor if he or she is trying to help manage your withdrawal....

 

I agree, that is the primary advantage.

 

Your overall argument is logical. Why not rip the bandage off all at once?

 

I'd like to point out some drugs are useful to keep the CNS relatively stable while another drug is being discontinued. For example, I personally would taper off an antidepressant before tapering off Seroquel or a benzo -- if you are already taking these drugs -- because Seroquel or a benzo might help minimize antidepressant withdrawal insomnia and anxiety.

 

(I am not in any way suggesting taking either to minimize antidepressant withdrawal symptoms! Taking Seroquel or benzos is a deal with the devil -- they also have terrible withdrawal problems.)

 

I also believe that simultaneously quitting benzos and antidepressants is perhaps the worst withdrawal strategy possible. Antidepressant withdrawal will knock out the regulatory effect of the serotonin system and benzo withdrawal will knock out the regulatory effect of the GABA system. Then you are trying to recover without two very important mechanisms for recovery. Ouch!

 

....

In any case, I believe you are doing the right thing for yourself and I tend to agree with your logic and reasoning, however your method would likely be too complex and confusing for most people to navigate through.

 

Hence, this is why the "one drug at a time method" seems more reasonable and practical to promote....

 

As Alto stated, you appear to be very in tune, observant, not to mention, very intelligent educated and aware, perhaps even very intuitive and thus, are able to differentiate and distinguish what is going on and when and thus, how to control the whole process....

I also agree with Punar and, as it turns out, myself.

 

One needs to be very, very attuned to one's reactions to control a variable rate of taper of even one drug, much less multiple. I've done this myself and I know how difficult it is. You have to ask yourself, "when withdrawal symptoms appear, do I go up or down? And how much?" This can be very nerve-racking, not to mention what happens if you make a mistake.

 

What we try to do is give people enough information so they can manage their tapers and their symptoms. Particularly adept folks can tailor withdrawal to their own needs.

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alexjuice

In my current situation, I am continuing to take benzos, no taper.

 

I have a long, hard history with benzos and I fell to pieces the last time I adjusted the dose. I didn't even exactly reduce it so much as I manipulated it -- though the way I manipulated it probably equated to a reduction.

 

I have made that deal with the devil. I think the benzos put a ceiling on my Effexor w/d. But I still have so many problems that I can't tell what is what. For instance, I have both LPR (reflux damage to vocal cords) and muscle tension dysphonia. Combined I can barely speak.

 

I've been on the same benzo mix for 3 mos and I haven't returned to my level before the adjustment that set in motion the round of problems that led to my speaking problems. Though things are much better. If I could talk, I could probably work if the work didn't involve physical labor or mental concentration. I'm not joking. Like, I could probably make sandwiches or something. Seriously, that'd be a good step.

 

I'm not really getting better, or maybe I'm just not getting better fast enough. I'm tired of being disregarded by doctors - today I had a followup with an ENT that went poorly after he played the 'anxiety' card. Nobody I've spoken to knows nada. It's like I have this huge information advantage but I am the patient. I can understand Rhi about this. My helpful shrink has no freaking clue what to do, basically whatever I think. Other docs say all my problems are do to anxiety or offer Freudian explanation. Yet they have no recommendation about medication. I pay doctors to hear the same thing, "I don't know." and "It's possible, I guess" and "I'm not sure why that would happen" This gets wrapped with shrugged shoulders, "That's, ummm, well it's hard to say...Hmmm...Okay, take care... Next patient."

 

I'm too paralyzed to do anything but hold. Though my whole life hinges on maintaining functionality -- I am enduring this right now for the opportunity to prove my innocence and ability so to speak -- and I feel my foundation is unsound so long as I am relying on Valium & Klonopin which may fail me at any time.

 

Nobody listens when your 'crazy'. You must take drugs to control the 'crazy'. But the drugs cause the 'crazy'. But stopping the drugs also causes the 'crazy'. Of course, you must pay for the drugs as well as time of the people providing them. You weren't crazy until they said you were crazy and put you on the crazy-catch-22 drugs.

 

This is a beautiful system.

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Rhiannon

Definitely don't try to taper a new med or another med while you're still recovering or in withdrawal from tapering a previous med.

 

I'm a strong proponent of taking your time and only starting a taper when you're feeling stable, and staying stable during the taper process by taking it slow and holding whenever things seem to be speeding up. And holding for as long as it takes.

 

Rather than reinvent the wheel, here's something I wrote in a conversation on the benzowithdrawal board:

 

Here's the post I was replying to: "After a partial reinstatement (to .5mg) in order to keep working after crashing going from .25 mg. klonopin to .2 mg too fast, I have not been able to get a taper going now matter how glacially slow I go.

 

Struggled my way down to .43 since resuming taper in February, then started holding in June after what I thought were minor problems. Held for nearly 9 weeks, then figured as long as I'm suffering I might as well be cutting something.

 

Started cutting at the ridiculously slow rate of 1% every 28 days. After only three days of cutting at this rate, I noticed things getting worse, kept going till the 7th day which would be 1/4% and it started getting really bad. Put back the 1/4% and hopefully the new symptoms have died down...Still in monitoring mode on that.

 

While I realize I probably shouldn't have started cutting while I wasn't completely stable, it seems really absurd to have no improvement after holding 9 weeks, and then reacting to such miniscule cuts.

 

Guess everything has really changed since the reinstatement. My original taper from 1 mg to .25 went relatively smooth"

 

and my response:

 

It's not absurd. It's how it is. Your body/brain is telling you that it's still hurting from everything else that's happened as a result of the ups and downs in the past, and it needs more healing time. Brains don't grow and heal fast.

 

There are two things that I think people need to "get" about these drugs and what they do to us and how we heal.

 

First: When you take a drug that screws around with the chemistry of your brain, your body/brain sees this as a life or death situation. We are not designed to have our brains screwed around with. Your brain responds by, among other things, killing some cells and growing new ones. It turns off some genes and turns other ones on. There are dozens of different kinds of cells in the brain and they all have to adapt and change when the chemistry is screwed with. Your body/brain tries to alter itself, to wrap itself around this new artificial chemistry. These are not small changes. These are major, traumatic adaptations.

 

Each time the drugs are switched around--whether they are cut, or increased, or changed to other meds, et cetera--whatever processes have already been happening have to try to stop and go the other direction. (Or maybe a couple of other directions.)

 

This is not simple. This causes more trauma, more chemical chaos, more damage. Processes that cannot be quickly halted and are already out of control, try to counteract themselves using other processes that are very imperfect as well. (Imagine the LA freeway system if all of a sudden everyone had to stop and go the other direction, but there were no lights and no traffic cops. And everybody's brakes and steering were already kind of busted and unstable to begin with.)

 

All the chemistry of the brain is connected. Every reaction affects other reactions downstream.

 

So this is huge. We SO underestimate the complexity of our brains. They are incredibly complex, comparable to a jungle in complexity. (Much more complex than the LA freeways.) Everything affects everything else in feedback loops upon feedback loops.

 

Screwing around with neurotransmitters is a BIG DEAL.

 

The second thing: Our brains do NOT know how to do this.

 

See, with other kinds of healing and adaptation, we take so much for granted. Our bodies know how to deal with changes in food, water, with traumatic injuries to our skin and bones and organs, with stress and survival issues--all of these things, we have encountered zillions and zillions of times over the past five billion years of evolution, so we have developed efficient mechanisms for balancing and healing. NOT WITH THESE DRUGS.

 

No brain of any organism on the planet has ever encountered anything like what these drugs do to us, ever before. What mechanisms our brains have to deal with changes in neurotransmitters are designed for much subtler alterations--alterations due to hormonal changes in puberty, for example, and pregnancy, and with aging; alterations due to changes in patterns of light and darkness with the seasons; that sort of thing.

 

These drugs are to the natural variations that we're designed for, as the atomic bomb is to a rockslide.

 

So--the point of this whole lecture is--IT'S NOT ABSURD. Listen to your body and brain. Give it the time it needs to heal and to adapt. There's chaos, there is the brain equivalent of scars, there's all kinds of perturbation happening. It's going to take time for things to settle down and heal.

 

You can go ahead and push through and let your brain cope as best it can until you get all the way off the meds. Likely you will be symptomatic the whole time. Then once off the meds you can go through the prolonged process of healing from the chaos and damage that has happened.

 

Or you can allow enough healing time now, and then, when things are healed and settled down, start a very slow (it will have to be slower than ever before, because of the previous damage) taper that will allow your brain to heal and recover and adapt as you go, without inducing so much chaos.

 

At least, this is how it seems to me. This is the paradigm that I operate from. It seems to be the one that best fits the observed facts of the experiences people describe.

 

So--do what you wish, I've given up trying to get people to understand the importance and urgency of respecting the complexity of our brains and the seriousness of what these drugs do to them. I write and write but it seems like people just don't want to hear.

 

But if nothing else, please don't kick yourself because you don't seem to be healing fast enough. This is NOTHING like healing a broken bone.

 

In fact I almost cringe when people on this forum use the word "healing", about the healing from this kind of trauma caused by the chemistry of psych drugs--not because it's not healing, but because it SO doesn't fit all the assumptions we have about how healing is supposed to go.

 

And people suffer, and fear, because they know intuitively that this isn't what healing is supposed to feel like.

 

I almost wish we could call it something else so people would understand, this is not something our bodies know how to do! they're improvising, doing their best, but it's not efficient, it's not always effective, and we need to allow lots of care, and patience, and time, and adjust our expectations.

 

And be gentle. Work with our body/brains, rather than fighting them.

 

I hope this helps.

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Rhiannon

"Nobody listens when your 'crazy'. You must take drugs to control the 'crazy'. But the drugs cause the 'crazy'. But stopping the drugs also causes the 'crazy'. Of course, you must pay for the drugs as well as time of the people providing them. You weren't crazy until they said you were crazy and put you on the crazy-catch-22 drugs.

 

This is a beautiful system. "

 

Sigh...so true.

 

Hang in there Alex.

 

And don't tackle the benzos now. You can do that later. I have lots of information about benzos, and there's lots of support and info about those elsewhere on the Internet, more than for ADs I think.

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Rhiannon

and one more post:

 

I still think people should not be told that one drug at a time is the only way to go.

 

At the very least, I think people deserve to be told that there's no real scientific evidence that it's better.

 

It's true that I have lots of resources--information, intelligence, self-awareness. But I also have some distinct disadvantages too. Primarily a 20-year history on multiple psych meds with numerous changes and CTs and many years of extreme instability and suicidality, including two suicide attempts and one psychiatric hospitalization. Decades of misery, suffering, instability, not being able to function, not being able to think logically and make good decisions, extreme "medication spellbinding."

 

Lost everything--my financial resources, life savings, home--worst of all, 20 years of my life, any chance at a successful career and financial stability.

 

I have a history of extreme reactions to drugs and withdrawal, including extreme suicidality and dysfunction. At one point I began the process of applying for SSI because I, and people who knew me, despaired of me ever being functional and stable enough to work for a living. I barely struggled through many, many years, just barely surviving, and very unwell. And every time I attempted to quit a drug I ended up sicker than ever.

 

And in spite of my extremely unstable past history and multiple drugs for many, many years, I'm pretty sure I'm doing better with a multi-drug taper than I would do with one at a time. I feel that I'm more stable staying on the mix and reducing them all slowly than I would be if I tried to pull out just one. My brain has adapted to the full blend. I've had the experience of cutting one drug at a time before, and this, for me, is working better.

 

(Although I have never tapered this slowly before, and I'm certain that it's the slow taper that's 99% responsible for my success. Slow tapering with holds is by FAR the most helpful piece of the puzzle.)

 

I know I'm just one person, and what's true for me may not be true for everyone else; but I think people deserve to know that this possibility exists. I believe in allowing people access to information and trusting them to figure out what's right for themselves.

 

And reducing them together does NOT take away the protective effect that they can have synergistically.

 

For example, as I'm still taking Lamictal, I get the protective effect that it provides (it's quite helpful for that glutamergic instability thing) BUT I also get an ongoing reduction in the nasty side effects it causes. Since the other drugs are going down too, I don't need as much of the Lamictal to still get the protective effect. And I do get to benefit from improving cognitive status and less suicidality as a result of reducing Lamictal.

 

And since every one of these drugs causes side effects and is toxic, I'm reducing the synergistic toxicity and side effects as well.

 

Because I am NOT saying that you should just cut a bunch of stuff out at once. I am saying SLOWLY TAPER them all at the same time.

 

And I think people need to know that there have been no studies of any kind, no actual proof of any kind, showing that one drug at a time is physiologically advantageous.

 

So: it boils down to:

 

one drug at a time is easier to keep track of and control

 

but

 

multiple drugs at a time can also be controlled if you go VERY VERY SLOWLY AND CAREFULLY--I can't emphasize enough the importance of going slow and holding frequently, but I think that's just as important if you're tapering one drug only;

 

and other than that, we don't know jack, and we need to be honest about that.

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Altostrata

....

So: it boils down to:

 

one drug at a time is easier to keep track of and control

 

but

 

multiple drugs at a time can also be controlled if you go VERY VERY SLOWLY AND CAREFULLY--I can't emphasize enough the importance of going slow and holding frequently, but I think that's just as important if you're tapering one drug only;

 

and other than that, we don't know jack, and we need to be honest about that.

 

Rhi, I agree with everything you've posted today.

 

The only thing we know is gradual reduction is better than sudden reduction.

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Altostrata

A note here: My comments tend to be conservative because I don't want anyone hurting him or herself by doing something rash. That's why we start with suggesting a 10% trial taper.

 

Of course, once you find how any method works for you, you can modify it as your brain and body require.

 

Rhi, it's interesting that you mention Lamictal seems to help with some of the withdrawal symptoms. Can you tell us more about that?

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Baxter

I read this thread earlier and it has been with me all day. Responding as a fellow long term/multi-drug/quick switch user feels like something that I should do. My histor is similar to Rhi's in many respects, including hospitalization and multiple drugs/ switches. I have been on the sh*t since 1989. Alto and Rhi,your grasp of neuro/brain/pharm knowledge continues to awe me.

 

What this thread shows me is that one needs courage to explore the right path out of the pharma funhose on one's own. Rhi's description of her experience is moving and profound; her conclusions are making me rethink my strategy. Those of us who have the pleasure of figuring out what to do with a cocktail of pharma delights might want to consider her conclusions. She is among the most articulate and knowledgeable folks in the community...

 

That said, the 10% until you feel better rule of themb is still a great starting point - but I wanted to give props to Rhi for coming out. And to Alto for responding so well.

 

Best wishes to everybody who is searching the internet for support and answers.

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Rhiannon

 

Hang in there Alex.

 

And don't tackle the benzos now. You can do that later. I have lots of information about benzos, and there's lots of support and info about those elsewhere on the Internet, more than for ADs I think.

 

Rhi,

 

Thanks for the kind words. I'll be asking you about benzos, you as well as some of the folks on the benzo board. I refer most often to benzobuddies but I think you're more active on a different forum.... I'm glad to have the folks we have on this board, especially Alto and Rhi because you guys advance reason and caution, virtues lacking among those wearing the 'expert' hats in this field. Honestly, people like you two are the experts. I say this as someone who spent four hours last week with paid experts who are completely clueless -- actually my docs have warned me to be cautious around the dangerous 'internet message boards', though I've been careful to only speak of my participation online very rarely and very vaguely at that...

 

In any event, this thread has brought up some memories of the painful, humiliating things I did ON Drugs and how I've been dealing with those feelings. I don't want to hijack the thread so I have posted that bit HERE for anyone interested.

 

Alex.i

 

I've had the chance to hear and follow so many tales of benzo withdrawal that I'm getting a sense of what works and what doesn't, and Alex I think you're in a good position to make it work when the time's right. The most important things seem to be: starting stable; tapering with small cuts and never letting the taper get ahead of you (always holding when symptoms start to kick in, not pushing it); taking your time (seems to take most people a lot longer than they hoped/expected); and not, definitely not, changing doses, stopping and starting, going too fast and reinstating etc. That whole reinstating business is tricky with benzos.

 

But oddly enough, it's looking to me like if you strictly follow those guidelines, tapering benzos can be fairly straightforward. In my own taper the Celexa is trickier.

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Rhiannon

A note here: My comments tend to be conservative because I don't want anyone hurting him or herself by doing something rash. That's why we start with suggesting a 10% trial taper.

 

Of course, once you find how any method works for you, you can modify it as your brain and body require.

 

Rhi, it's interesting that you mention Lamictal seems to help with some of the withdrawal symptoms. Can you tell us more about that?

 

I hope I've made it clear that the kind of taper I am discussing is far from rash. ANY taper of psych drugs should be done at a snail's pace, with care and awareness, unless there's a toxic reaction to the drug that necessitates a quicker reduction. Ironically, I'm known for being extremely conservative in my tapering advice. I usually advise starting with a 2-5% cut then increasing gradually as you see how your body is going to respond to the cuts. I also generally advise the "microtaper" method, tiny cuts more frequently, with intermittent holds to allow your system to catch up with the cumulative effect.

 

I just don't necessarily agree that "one at a time" is the most conservative or safest choice. Maybe it is, maybe it isn't. We just really don't know. Here, on this forum, where there is so much thoughtful discussion and intelligent participation, I think there's room for discussion of a variety of paradigms.

 

I guess, too, I'm partly driven by my frustration and disgust at how the "scientists" who developed these drugs and the marketers and publicists have managed to persuade so many people (including, for a long time, me) that they actually know what the drugs do to our brains. Fact is, the little bit they do know about what these drugs do in cell culture, or even in rat brains, is just a tiny, tiny piece of a puzzle that's mostly completely unknown. How dare they suggest that they know what picture the whole puzzle makes when all they have is a handful of miniscule pieces? A bit of blue here, a bit of yellow over there--oh, it's a toy truck. Except that once you add in the five million missing pieces it turns out to be a Brazilian rain forest. And, oh, by the way, my BRAIN, which you're pushing around on the carpet while making "vroom, vroom" noises.

 

I feel it's important--again, particularly here, on this forum--to be honest about our ignorance.

 

As far as the Lamictal thing--well, it's an idea I first was introduced to by you, Alto, because your doctor was using it therapeutically with you . But then I accidentally stumbled across the discovery that if I take my Lamictal dose about five or six hours before I would ordinarily be waking up, my morning cortisol response is dampened. And then there's the fact that it works on NMDA receptor ion channels, which is promising since there's so much evidence of glutamergic disruption in withdrawal.

 

So really for all I know it's not protective at all. I primarily mentioned it rhetorically--that is, as you had said, if a reason to taper only one drug at once was because the other drugs might be protective, I was pointing out that since the levels of the drugs are all going down together, you would still get the protective effect. And without having to be concerned that perhaps the drug you're tapering IS the protective one, the one that's protecting you from the drugs you're NOT tapering. (Again, if you're stable on the blend, then why wouldn't it be as safe, or safer, to maintain the synergistic blend as you reduce, rather than experimenting with changing the blend every time you pull out one of the drugs?)

 

I'm not trying to persuade anyone to do it like this, not at all. I just think the subject should be out there, should be on the table, should not be taboo or automatically discounted. This forum is the closest thing I've found so far on the Internet to a safe and productive place to discuss psych drugs and psych drug discontinuation and withdrawal, and it's a subject that needs to be being discussed and thought about by creative, intelligent, open minds, I think. So many people are already suffering so much, and it's just the tip of the iceberg. There's no time to waste.

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compsports

As one who tapered off of 4 meds at mostly the 10% rate, I find this discussion very interesting.

 

When I was on the alternative mental health yahoo groups list, someone advocated tapering more than 1 drug at a time so as not to upset the delicate balance the drug combinations were providing. I thought he had a good point but the reason I didn't consider it in my case was I wanted to save the medications, Doxepin and Remeron, which I was using for sleep, for last. I feared if I tapered them at the same time as tapering Wellbutrin XL and Adderall, I would suffer horrific insomnia.

 

Unfortunately, that happened anyway but still I think having to measure out more than 1 drug would have been a royal pain in the neck for me and would have been hard to keep track of.

 

But I think Rhi's arguments have alot of merit and l agree it is important to put all the options out there for people to consider.

 

CS

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Altostrata

Rhi, you speak logically. However, I am dubious that reducing all meds at once maintains a homeostasis. They all act differently. Some change metabolization as the dosage gets lower.

 

And if the whole thing starts sliding south, what do you do?

 

If you look at Lor95's situation, for example, she's dealing with Paxil and Xanax. It's unclear which drug is causing her symptoms, but she has to make a decision. In a rough spot, she has to decide whether to increase dosage, decrease, stay the same, or quit -- of both drugs.

 

With one drug, that's 4 choices. 2 drugs yields 16 permutations of decisions (4x4). 3 drugs, 64 permutations (4x4x4).

 

When one is already confused by withdrawal, having to make these decisions can be paralyzing and cause even more anxiety. Sometimes I have to keep notes and I'm only dealing with one drug now, at a taper of .1mg-.2mg.

 

In general, I'd stick to tapering one drug at a time, and I'd do the inhibitory drugs such as Lamictal and benzos at the end. My logic might be crude here, but as you say, there are no signposts, and at least I have a rationale.

 

The reason I'm crystal-clear and conservative about this is because the degree to which people will misinterpret this information cannot be overestimated. For example, I might suggest 500mg of delayed-release vitamin C twice a day and before you know it, someone will have taken 5000mg, figuring more is better.

 

Now, a person who thinks systematically, as you do, Rhi, clearly can handle a complicated taper of more than one drug at a time, with tiny drops. That option is open to everyone. (I'm actually a big fan of tiny drops more frequently -- but one drug at a time.)

 

It may very well be that your strategy of tiny changes in all drugs at once is working because of the tininess, not the simultaneity.

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Rhiannon

Logical? Yes, I seem to be doomed that way. My pull-down menu doesn't seem to have a Logic Off option. It's frustrating sometimes, but oh well, we do what we can with what we're given.

 

Like I said before, I'm certain that the slow taper with small incremental cuts and intermittent holds is by FAR the primary reason I'm doing so well with my taper. I've been saying all along that the only way this will work is if you go slowly, pay close attention, and adjust as needed. (And start from a stable place--also crucial, start stable.)

 

But all of that seems to be just as true of tapering one drug at a time. Especially in a polydrug situation.

 

I agree, as levels go down the interactions between the drugs probably change, due to differences in potency, chemical equilibria, metabolism, and Goddess knows what else. (The complexity of neurophysiology is impossible to overstate.)

 

But if that's true, then wouldn't that be all the more true if you are completely removing one drug at a time? That's really kind of my point.

 

We can't predict how the interactions between drugs are going to affect our tapers--if you're removing one, or slowly titrating them all together, either way. You can't presume that even one drug is going to behave consistently throughout a taper. (Benzos, for sure, have a nasty tendency to go paradoxical and generally defy all the rules.) Let alone one drug which is interacting with other drugs in a polydrug situation.

 

If the whole thing starts sliding south you do the same thing you do with a single-drug taper when the whole thing starts sliding south. You are going slowly enough to begin with that you catch it early; and you hold until things balance out again.

 

You do keep records and keep track of reductions; I chart my dosages and symptoms daily. If you're going slowly and paying attention, it's really not that hard to track back and figure out what's going on.

 

That's why I am such a strong proponent of slow tapers, small cuts, and intermittent holds. Absolutely the key IMO to any psych drug withdrawal; incremental changes, hold the second the symptoms ramp up, and throw away the calendar. You need to be going slowly enough to respond immediately when things start to go pear-shaped, and give your nervous system time to catch up.

 

That, actually, is bottom line why I am doing it this way--I think almost everyone greatly underestimates how much time our brains need to make the necessary adjustments to changes in their chemistry. I would probably not taper a single individual drug a lot faster than I am tapering my giant polydrug mix, because I want to give my brain plenty of time to adapt to changes, ANY changes. Time is more important, to me, than the number of drugs. Particularly since even one single drug has multiple effects on multiple systems, most of which aren't mentioned in the TV commercials.

 

Now, I absolutely do agree with you about people misinterpreting stuff, or using information in stupid ways. They do. I do, sometimes. But does that mean we can't ever discuss anything that somebody might possibly be stupid about? If so, then we'd better not talk about Lamictal and benzos being inhibitory, because people are going to go to their doctors and ask for prescriptions. I mean--I'm not trying to dismiss this concern at all. This is certainly a concern. It's really difficult. It's the greatest challenge of free speech. "Fire" in a crowded theater and all that. At what point do you suppress debate and discussion in order to save people from themselves? I don't think there's a simple or easy answer.

 

And I know that for you, Alto, as the primary mover and shaker of this forum, this responsibility must weigh heavy on you.

 

And I absolutely agree that this is NOT a path for everyone, maybe not even most people. In fact, I never actually advise it. When I'm giving advice on forums to people trying to taper multiple drugs, I always say to taper one at a time--for the reasons we've talked about, that it's easier to keep track of and control.

 

But I still feel like it's important to let people know that, number one, there is no actual science supporting this advice, it's just a matter of received wisdom and common practice and convenience; and, number two, there are people (I'm not the only one, I'm just the only one who talks about it so much publicly) who do well with careful multi-drug tapers, and feel that it's actually a better way to go, for them.

 

Plus, I think it's good to discuss stuff, to put ideas out there and encourage people to think about them for themselves.

 

Because we really do not know. And this (polydrug psych drug withdrawal) is going to continue to be a growing issue. I think we need to be willing to really deeply examine our assumptions and paradigms. Clearly modern psychiatry is way off base with a lot of their assumptions about how these drugs affect our brains. (For one thing, most of the assumptions they make about them are based on the pre-neuroplastic mechanistic paradigm of the brain as a wet computer.)

 

I mean, I feel strongly that we can't make that same mistake, just swallow what the "experts", whose track record is so abysmal on so many things, are telling us about polydrug withdrawal. They may be right. They may not be right. They've been "not right" before in some pretty important ways.

 

But if you'd rather close the discussion and remove it from this forum because of your safety concerns, I understand. I'd be sad and bummed, because this is the most intelligent forum I've seen, you are always interesting and stimulating to talk with about the deeper science issues, and there's nowhere else I can really talk about this stuff and get stimulating and useful feedback--but that's just me and my needs, probably not as important as the mission of the forum overall.

 

I'd like to know what other folks in this forum think about whole safety thing, "fire" in crowded theater versus the benefits of open discussion, thing, too.

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brighteningup

I think you should keep debates like this on the forum, especially when the contributors are as careful, clear and thoughtful in what you say as you both are Rhi and Alto.

 

It's really difficult when you're dealing with an area where there is so little reliable research, and there is also so much misleading information in the public domain.

 

Ultimately each of us has to make our own decision on what treatments we use and how we best reduce or change them, using the best information we can get.

 

I find discussions like this very helpful and thought provoking. Whilst they demonstrate how complicated this all is and that there are no easy answers I think they help us to make an informed choice and that's a really good thing.

 

Bright.

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Altostrata

Rhi, I do appreciate your bringing this up. I've never considered deleting or closing this topic.

 

Yes, this is a forum where we can discuss things responsibly.

 

I believe we do agree, or we don't significantly disagree.

 

On this site, tiny cuts are an entirely acceptable strategy. And if you feel you can manage reducing more than one drug at a time, it's up to you.

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Rhiannon

I agree that we don't significantly disagree. I have that "debater" in me, so it may seem like I disagree more than I do, because I enjoy the back and forth dialectic of mutually respectful debate. That's easier to pull off when you have access to facial expressions and body language--to make it clear that you're just debating concepts on their merits, but you still basically agree with and certainly respect, and like, the person you're debating with.

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Crocus

 

 

What we try to do is give people enough information so they can manage their tapers and their symptoms. Particularly adept folks can tailor withdrawal to their own needs.

 

What a great dialogue on this topic. For me, the above comment is still the bottom line. The information and resources are gathered here as well as members personal outcomes from the methods that we have all tried. Each of us must make our own choice on what works and monitor our own progress (a difficult task in the midst of brain fog, anxiety, etc.).

 

I had tried reducing more than one drug at a time and am having an easier time doing just one. And I respect that the opposite may be true for others and other combinations of drugs.

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Rhiannon

Hey, I just wanted to drop in and post on my continuing experiment on multi-drug tapering.

 

One of the reasons--well, actually, the main reason--that I chose to start out this way, is that all the meds I was on were having unwanted effects on my health, weight, cognition, and emotional states. I just couldn't pick one and say "well, this is the worst one, so I'll quit it and stay on full doses of all the other stuff." I hated what they ALL were doing to me. I hated them all equally and couldn't stand to keep taking a full dose of ANY of them. They were ALL screwing me up.

 

So when I started (21 months ago now) I thought, Well, it will be very slow, and I won't see much progress in terms of numbers getting low for a long time, but at least I will be reducing the effects of ALL of them every day.

 

I am very happy to say that I feel great now about that decision. I am SO much better! Now, after a very long 21 months, I'm down to half or less of my original dose of everything except the Lamictal, and I'm down from 200 a day to 122 a day of that.

 

And I've noticed improvement in every area of my feelings, my life, my ability to get out and do things, my stability, everything. My cognition, although still foggy, is definitely clearer. (I'm the only person I know of my age whose memory is actually improving.)

 

I'm able to feel my emotions better, and they're more normal, not so much of those strange--well, I don't want to take the time to describe it in depth, but the emotional states caused by these drugs are abnormal and strange, although it's hard to see that when you're in them. And I'm starting to be outside of them enough to see that.

 

My creativity is still numbed, but it's coming back! And libido, too! It's like the fog is thinning out, things are becoming clearer.

 

At the end of a long hold recently, when I stabilized, I enjoyed about two weeks of actually feeling happy and contented with my life--and looking forward to the future. I don't remember the last time I felt that way when I was on the drugs.

 

I haven't had a spell of suicidality (my constant companion for 20 years on antidepressants and other psych drugs) in over a year, and right now I can no more imagine harming myself than trying to kill someone else. (I have a history of two suicide attempts and coming very close to a third, on the drugs).

 

I haven't been this stable in 20 years.

 

In short--after a very long 21 months of tapering I am realizing that the worst is already over! The worst, for me, has been what I have experienced due to the effects of the drugs themselves. I do get nasty withdrawal symptoms, but I'm getting the hang of pacing myself and holding as needed, and the withdrawal now causes me less suffering and less disruption than the drugs themselves were causing. And I get breaks from the withdrawal whenever I hold for a while.

 

Of course, I still have many more months to go. I think it will probably be three more years before I am off of everything. That's the price, that's the trade-off, you have to just let go of the "finish line" mentality. It's a voyage, not a trip with a destination. This IS my life.

 

I'm willing to take longer if that's what it takes, though, because I can see I'm not going to have to wait until the end to get myself and my life back. Being on lower doses of everything has already brought so much improvement.

 

Please, don't anyone take this as a sales pitch and suddenly question what you're doing or suddenly change what you're doing. I just want to keep reporting my story and experience with this experiment, because I think people need access to this information.

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Barbarannamated

Rhi,

that is GREAT to hear!! When I first read your hypothesis, I was surprised, but it definitely made sense. Like wildfire creates its own weather system, the drugs create their own 'synergistic' storm, so to speak (although synergistic, to me, implies a good thing).

i fully understand 'Do NOT try this on own!" as you emphasized. Very interesting and encouraging, Rhi!

To continued success and good days!

Barb

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Rhiannon

Lisa, I wouldn't advise starting to taper new meds so soon after quitting Abilify. I think it's better to allow more time, to make sure everything's in balance and homeostasis is solid, before starting a new taper.

 

To give you an idea of the pacing I use with my multidrug taper: In two years I tapered from 200 mg of Lamictal to 115 mg of Lamictal. In that same time I tapered from 10 mg of Celexa to 3.7 mg of Celexa.

 

If you want to consider tapering meds together you MUST be prepared to taper at this kind of rate. My Lamictal cuts are 1 mg at a time.

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Rhiannon

In the ongoing saga of my multidrug taper: I'm now under 10 mg of Neurontin. I decided to hold the taper on the rest of my meds and just taper the Neurontin.

 

It didn't really work out for me. I found that even while holding the other meds, I couldn't taper the Neurontin much faster, I was still getting withdrawal symptoms (even at this low dose!) The Neurontin symptoms are distinctive (hot flashes and dizziness along with a certain less-distinctive cognitive distortion).

 

I was also having some other new symptoms--more fogginess, sleepiness during the day, which I suspect may be due to holding the other tapers, since my genes have been reset to work with gradually decreasing drug levels.

 

I went back to tapering them together. Seems to work better for me. Unfortunately, in this case, since I'm very impatient to finish up this Neurontin! (Down to 5 mg today!) Hopefully I will be able to take my last dose before my birthday on April 11th.

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Rhiannon

Good to hear you're making progress, Rhi.

 

What kinds of decrements are you making in the Neurontin?

 

Alto, right now I'm going down by 0.5 mg at a time. I went down by 5 mg in three weeks and was forced to hold due to withdrawal symptoms which just didn't settle down. I went ahead and did some small cuts in my other meds then. Things seem to be settling down but I'm holding at 5 for a few more days--those other cuts will need a little time to balance out now. But the fogginess is clearing.

 

It's just so frustrating that even when I hold everything else, I can't just jump right off even this low dose of Neurontin.

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Barbarannamated

Rhi ~

Good to see you :-)

 

Would you briefly describe 'cognitive distortion' and how it differs from DP/DR or other perceptual distortions

Barb

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Rhiannon

Barb, I'm just using that as a catchall term for noticing that my thinking is a little wonky. It's a hard thing for me to catch because when my thinking is wonky I usually can't tell it's wonky because the wonkiness makes it harder to see the wonkiness, if that makes sense. But sometimes I can sort of catch it out of the corner of my eye. Mostly I can spot it because of my behavior--I'm saying and doing things that are a little weirder than usual.

 

This is a really, really tricky one for me. Peter Breggin talks about something called "intoxication anosognosia" or "medication spellbinding". I've read his book Medication Madness and it helped me understand some of my bizarre, self-destructive behaviors on psych meds. I don't act that bizarrely most of the time now but I do have some dysfunctional behaviors and compulsions.

 

Anyway the thing I was having recently (it seems to be settling down) felt like a sort of cognitive and behavioral "wobbliness." I don't think I can explain it. Just catching it sort of out of the corner of my eye, "hm, that's a little weird"...

 

It's not DP/DR--I've had DP/DR episodes my whole life since experiencing extreme abuse as a kid, so although I do experience it as a withdrawal symptom, I don't find it as upsetting as most people seem to.

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Rhiannon

Update Star Date Now:

 

Well, quitting the Neurontin has been more challenging than I expected after such a slow taper and getting off at such a low dose. (I tapered down to 1 mg and then off.) Manageable, in that I have still been able to keep my job, which is sort of my bottom line; but I've been more symptomatic for longer than I expected. And it's a slightly different kind of pattern of symptoms.

 

Hard to describe the difference but it's like, something that was providing a certain kind of balance or rudder is gone, so when I get anxious or panicky it emerges more suddenly and escalates faster. Having actual panic attacks sometimes, not just generalized anxiety and edginess, although I have that too.

 

Having to be more careful about interdose withdrawal and making sure I take my doses right on time. Less slack.

 

I can't say I'm sorry I got off though. Getting off Neurontin was always a priority for me because it destroyed my ability to remember things, and being able to remember details and multi-task is vital at my job. That has definitely improved all the way down the taper and I think it's still slowly improving now. I'm curious to see what happens with that in the coming months. Have definitely been having moments of intrusive memories, but that's been a constant throughout withdrawal and happens with other meds besides Neurontin, I'm told.

 

But I have to say this experience has reinforced my sense that it's better for me to taper them all together, so that they continue to interact in the ways that my body has adapted to, rather than pull one out of the mix at a time. It definitely feels more challenging to cope with this transition than with my previous withdrawal symptoms.

 

I'm holding now, until my system can develop a new homeostasis. This is new to me, a first in this taper, so I don't really know what to expect. Tentatively planning to hold until the end of July at least.

 

I really didn't think that last 10 mg of Neurontin could possibly be doing much. Amazing how powerful these drugs are at even small doses (Neurontin is usually prescribed in four-figure doses). And maybe more so with the synergistic effects.

 

So, it will be interesting to see how this plays out. I think it may take some time, but that's nothing new.

 

Just wanted to update in this topic and let y'all know.

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Rhiannon

DOING BETTER AT LAST!

 

Whew!

 

My daughter's getting married next week, so I'm going to be pretty focused on that now, but I did want to drop in and let y'all know that the post-Neurontin mess seems to be resolving. I'm doing well and I seem to be functional enough that I should be able to handle the upcoming craziness and maybe even enjoy some of it. Thank goddess, I was starting to be afraid I hadn't given this long hold enough lead time.

 

Will be continuing my current long hold until about a week after the wedding and then begin to cut the Lamictal again.

 

Y'all take care and I'll be back!

 

:-)

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Rhiannon

Back from the wedding and yes, it was pretty much wonderful. Also lots of other emotions. I'm so grateful that I'm able to be present and be a rational grownup and to actually feel my feelings and the fullness of my love for her--probably not as much as I would without the drugs at all, but much more than I have been able to for about the past 20 years.

 

I think I'm mostly over the Neurontin withdrawal, as far as I can tell. Just made some more cuts yesterday in my other meds; going to emphasize the Lamictal for a while, but in my case that means cutting by maybe 2 mg a month. Lamictal's a tricky one, for me.

 

I'm also working with something called "limbic retraining" for my multiple chemical sensitivities. It's based on neuroplasticity and engaging the brain's built-in systems for calming the amygdala (the source of the "fight/flight/freeze" reaction to trauma and stress.) So far, it's been helpful with my withdrawal symptoms. I think it has the potential to help people with protracted withdrawal and post-withdrawal neurological damage as well. We'll see how it goes, I'll post more as I learn more.

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Rhiannon

I just wanted to add an update to this thread in general: I'm off the Neurontin now and having only very minor withdrawal symptoms from time to time. It's settled way down and is continuing to improve steadily. I'm back to tapering my other meds, very slowly.

 

I've reached the point where the meds themselves are causing me less trouble, fewer symptoms, less disruption to my life, less dysfunction, than the withdrawal symptoms. That was not the case for a long time (well, about 20 years, really, plus the first couple years of the taper). I can feel my feelings, I connect well with other people, I enjoy social activities, I'm dating, I'm doing well at my job, my memory is better than it's been in many years, and I'm feeling healthier and more energetic than I have in many years. And let me say

 

HOORAY!!!

 

So, still tapering, but still no rush; even less rush than before, actually, because the drugs aren't ruining my life and destroying my ability to function and connect with others the way they used to when I was taking "normal" doses.

 

I'm still very glad I decided to do the multi-drug taper. I feel strongly that reducing the whole interacting mess together has been easier on my CNS than pulling one out all the way, then another, etc would have been; but more to the point, I'm not on full doses of any one drug, and I think that has made all the difference for me. This is exactly what I had hoped would happen. I'm down to either very low or fairly low doses of everything except that damned Lamictal (103 mg right now) and I'm getting myself and my life back.

 

Let me say again: the key to making this work is taking it very slowly.

 

In two and a half years I'm down from 200 mg Lamictal to 103; 0.75 mg Xanax to 0.255; and 10 mg Celexa to 3. Done using liquid titration in very small increments with breaks between and intermittent longer holds of up to two months.

 

This is after a 20-year history of polydrugging. It's possible I could do it faster, but I like feeling good for the first time in 20 years, and I feel very protective of what's left of my brain. I only seem to have one, and I need it.

 

--Your Intrepid Guinea Pig

 

PS: Although I will personally continue with my multi-micro-taper, I'm beginning to think that a more viable option for many people-- which would confer most of the benefits of the multi-drug taper--is to focus on reducing doses of one drug at a time.

 

In other words, taper one med down to 3/4 or 2/3 or half the original dose; then taper another one; then another one; then go back to the first one and reduce it more; et cetera.

 

This way you're still only tapering one at a time, but you're also reducing the full load together as a mixture, rather than forcing your brain to adapt to a complete transition off one drug entirely. I really think it's easier for the system to adapt this way.

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Rhiannon

Hi all!

 

Time for an update in my ongoing adventure with the multi-drug taper.

 

From the beginning I always thought of this as an experiment and knew that at some point I might have to start tapering only one med at a time. I think I'm getting close to that point. For now, anyway, because I need to get my Valium dose down quickly, I'm going to be holding my other meds at doses I feel okay about, and tapering only the Valium until I'm down to 1.5 mg (or if it goes smoothly maybe even lower but probably no lower than 1 mg). 

 

It will be interesting to see if I can taper the Valium faster while holding the other meds. In the past that hasn't been the case so much, surprisingly. But I've never tried it for a prolonged hold--this time if I can summon up the self-control I'm going to try to hold everything except Valium for six months.

 

After I get the Valium down I'm going to work on just the Lamictal for a bit, I think. I'd like to get it down to 50 mg or less.

 

Now that I'm down to my last 1 mg of Celexa and 0.125 mg of Xanax I'm feeling like it might be time to taper those by themselves too. We'll see. The Valium taper will keep me busy till August at least.

 

Anyway, just wanted to update that I'm getting to a point where I'm changing my approach.

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Rhiannon

Here's an update today, a copy of a reply I wrote to someone who asked me in my thread about my multi-drug taper:

 

Here's an old thread we had on the topic of my multidrug taper:

http://survivingantidepressants.org/index.php?/topic/1070-taper-more-than-one-drug-at-a-time/

 

That was sort of early days, forum wise. Since then I have seen that in real life, most people who try to taper more than one drug at a time push it too hard and too fast and get into trouble. Also, it requires so much more self-awareness. You absolutely have to listen carefully to your body and let it be your guide. 

 

It takes time to learn what signals to listen to and sort out the signal from the noise, and I still struggle with that from time to time. 

 

To taper more than one drug at a time requires very gradual and careful self-experimentation over a long period of time so that you can sort out which med is causing which symptoms. AND you have to be willing to just hold everything if things start to go bad and you aren't sure what to adjust. AND it's not safe if you're not pretty stable to begin with IMO.

 

But as you can see it has been very successful for me and I wouldn't do it any other way. I love it.

 

HOWEVER: As you can also see, I've been tapering for five years, and I will probably be tapering for at least four more. So if you aren't willing to take it that slow, don't try it.

 

Another approach, and the one I nowadays usually advise when people need to come down off multiple drugs and want to make some progress on more than one, is to alternate. Taper one for a while, then give that one a rest and taper another one for a while, then go back and taper the first again. That's something I do, too, as part of my multidrug taper; for example right now I'm holding the Lamictal, tapering the Celexa at a glacial speed, and focusing on the benzos.

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elbee

KarenB just turned me on to this thread. THANKS RHI! I've gone with the multi drug taper, too . . . and it's worked well for me! Your progress and your journey is inspirational! :)

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Hibari

I did a dual drug taper as well till I got to the lower doses of my first drug.   Then I concentrated on that till I was off-now just the Lamictal to go.

 

I'm glad I did the dual taper as well. 

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GreenFlameTiger

I am currently tapering down my Olanzapine. I started in 2013 so as you can see it's very slow going :P. Lots of learning along the road but I've gotten A LOT better. I'm almost finished with the Olanzapine but I find that when I drop the dose I tend to have trouble sleeping. So my brother suggested that I start tapering the Lamotrigine I'm taking. So continue at the dose I am at with Olanzapine and begin a micro taper of Lamotrigine. Is this advisable? Thank you all for your time.

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