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Damienpryan

When to end the taper and jump to zero?

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Damienpryan   
Damienpryan

Hi All,

 

Apologies if this has been done to death...

 

I was playing around in excel with a taper protocol and thought I'd share.

 

The 10% is a good rule and very good at encouraging people to go slowly.

Something a lot of us have trouble with. (well me anyway...)

 

But like Achilles catching the tortoise, reducing 10% will never get you to 0.

(An aim a lot of us have).

 

I've plugged the following rule into excel (attached) to see how it comes out.

Rule 1:

new dose = old dose - (9% of old dose) - (1% of original dose).

You plug the starting dose in and it will always taper to 0 in 24 months.

Now this may be to quick for some which brings us to ....

 

Rule 2:

If you feel moderate to nasty withdrawal effects then stop and stabilize.

After stabilizing restart taper from current dose.

(which will also reset the end 0mg end point to 2 years from current dose).

 

 

Here is an example of the output for a 20mg taper (though just an example!!)

Month Dose

1 20.0

2 18.0

3 16.2

4 14.5

5 13.0

6 11.6

7 10.4

8 9.3

9 8.2

10 7.3

11 6.4

12 5.7

13 4.9

14 4.3

15 3.7

16 3.2

17 2.7

18 2.2

19 1.8

20 1.5

21 1.1

22 0.8

23 0.6

24 0.3

25 0.0

 

I'll probably look to start this from my current 2.5 mg Lexapro , thus aiming to be at 0 in 2 years.

 

Cheers

 

Damien

ssri_taper.xlsx

Edited by ChessieCat
corrected fee to read feel

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mustangwoman   
mustangwoman

What do most people here recommend as the drop off dose, or last dose before stopping ssri?

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DLB   
DLB

Thought I could do it at 1 mg. but I dropped to .8 and had real bad couple of days so I think I will go all the way down to a miniscule amt.

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Ever   
Ever

I ain't jumping off till I do the 10% down to almost zero. Too many bad experiences jumping off too soon. Learnt my lesson and now think what's another year or two matter when the alternative might be suffering for years.

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mammaP   
mammaP

I jumped off Effexor at 1mg, (5 beads) and had awful withdrawal. I reinstated 20 months ago and

have only reduced by 3 beads in that time. Everyone is different but it is astonishing how bad things get

when stopping too soon at such a small amount. 

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Rhiannon   
Rhiannon

As always, though, your body is the expert on tapering, not a preplanned calendar. We just say 10% of the current dose as a general rule of thumb, a starting off point. How we tolerate reductions is very individual. Making up a plan or calendar ahead of time can give you some ideas, but I can't tell you how many of those I've had to throw out the window when my body made it clear that it does not heal according to a schedule I devise. 

 

Overall, at the lowest doses it's best to go very slowly, in my opinion. The upside of that approach is large: You can minimize the chance of going too fast, getting sick, having to reinstate and start over, and all the disruptions and misery that come with withdrawal. And the downside is very small: at such a low dose, the side effects and dangerous drug effects are minimal, and if you go slow enough to keep feeling good you'll already be enjoying many benefits of coming down to such a low dose so you won't be feeling the need to hurry.

 

So I would say, make those last cuts small and the breaks between them long. Take your time. I have seen many many people get into trouble and fail tapers because of going too fast at the end, but I've never seen anyone fail by going too slow.

 

Let me add, as someone tapering, I know this is easier said than done! You get close to that finish line and you want to rush there. But this is really the time when going slow will give you the maximum benefit for the minimum price.

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cymbaltawithdrawal5600   
cymbaltawithdrawal5600

You may want to read this journal, talk about a microtaper and when he 'jumped off'. His ending dose was so small it reminded me of homeopathy. But he had symptoms the whole time and he was willing to be patient.

 

It is always a good idea to taper as slowly as you can. This is not a race, you only hurt yourself by jumping off prematurely. If you have to updose, your taper is prolonged.

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AmyK   
AmyK

Hi! At what dose would you stop sertraline/zoloft? I am down yo 2.23 mg now. But I guess I am not ready yet. The last drop was totally awful.

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Altostrata   
Altostrata

AmyK, I moved your question here. I think maybe you answered it yourself.

 

If you're having withdrawal symptoms as you get close to the end, a long hold may be called for so your nervous system can settle down for the final push.

 

As to how low you'll need to go -- maybe others have a guess?

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Risperdrawlin   
Risperdrawlin

Hi, can anyone who has come off Risperdal safely and relatively easily tell me at what dose they jumped off? I'm currently on 0.0625 mg. Today was my sixth day on it. I had cut 50% from 0.125 mg. I am thinking I will jump off after spending a month or two at 0.03 mg or 0.01 mg depending on how I feel. I might also jump off after some time on this dose, 0.0625 mg, if a decent amount of time goes by and I do not experience withdrawal symptoms. What have other folks done?


 


Thanks!


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kristinacc   
kristinacc

I'm sure this has been asked already in the forum. However, I've looked and can't seem to find it. 

 

I'm currently at 4 mg Prozac. I've been reducing by 10%. It seems you could go forever with the 10% reductions so, my question is at what level do you quit tapering and go to 0. Would it be 1mg? My withdrawal symptoms have never been anything more than chest pain, and agitation when doing it this slow, but I fear for that actual point in which I stop medication altogether. 

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brassmonkey   
brassmonkey

Hi Kristin-- yea, we have a thread about that: Tapering to zero -- when do you just drop off?

 

It is best to go as low as possible before jumping off.  It makes the taper frustratingly long, but it sure beats having reinstate, stabilize and retaper.  According to the charts the range from 5mg to 0mg is the place where most of the changes take place.  A very small change in dose makes for a very large reaction in the CNS.  Many people I know, myself included have really noticed this.  It is generally recommended that people go to 0.5mg and if possible even lower before taking the plunge.

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Rhiannon   
Rhiannon

Be sure to take a look at the charts here:

http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

 

You can see why it's particularly important to go slowest at the end. 

 

At 40 mg of Prozac you have something like maybe 85% receptor occupancy, but it goes down in a curve not a straight line, so at 1 mg you still have something like 15% receptor occupancy.  So people often find that's still a bit high to jump off.

 

It's highly variable from person to person though, and it sounds like you're doing well with your taper. I don't know, I'd be inclined to say go on down to 0.5 mg, anyway, if you don't have some pressing reason to need to get off faster (like pregnancy or something.)

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nonliving   
nonliving

What is the last dose to just quit it ? I beleive dose below therepeutic dose would be safe as the drug is no longer doing anything to our system. Is it so ?!

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Altostrata   
Altostrata

"Therapeutic dose" means absolutely nothing. It's an arbitrary number from the drug companies.

 

You may not be feeling anything from the drug but your system can still be dependent on it. That is not a valid way to decide when to simply quit.

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Junglechicken   
Junglechicken

Have been thinking about when I should do my next drop.

 

Although I feel as though I have stabilised over the last few weeks, I should probably hang on a couple more months to be sure.

 

Also, I could be starting work soon so all the more reason to wait I guess.

 

Have answered my own question, lol

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marie123   
marie123

I had to reinstate 1 mg Trazodone after I jumped at 4 mg. I was surprised with withdrawal at 1 1/2 months. I did not have too much of a problem tapering to 4 mg, but when I got hit with withdrawal I had so much nausea for another 1 1/2 months. The reinstatement worked and I am waiting another month before I slowly taper from the 1 mg. I wonder how slow I should go?

 

Marie

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KarenB   
KarenB

The 10% rule still holds at this lower end, in fact it is especially so at this end.  I'm just looking at your last sig. line of tapering details and seeing a fairly quick taper then a big jump to 0.

 

I'd suggest tapering by 10%, holding a month, and then considering your next move.  I don't want you to end up having to up-dose again, cause each change causes further instability for your CNS.  Slow and steady is your safest bet. 

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marie123   
marie123

KarenB thanks for your advice. I know slow and steady is the way to go. I can't help, however, thinking about the Remeron taper I'll have to deal with when the Trazodone is finished. You know the longer I'm taking the Remeron the harder I think it will be to taper. That's my train of thought. I've taken it for 2 years now and it's time to go!

 

Marie

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KarenB   
KarenB

I know - so frustrating.  However the whole thing will be faster if you don't take risks and have to backtrack etc.

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rapunzel2   
rapunzel2

What's the jump off dose of seroquel? any insight, experiences?

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music321   
music321

The last time I came off of prozac, I tapered down to 0.4 mg, then went cold turkey from there.  I had withdrawal reactions for a few months.  Since then, I came off of a far higher dose, far too fast, and crashed hard.  So, I'm wondering how far I should taper before stopping.  Going from 5 mg to 1/100 of a mg, at a dose-adjusted rate of 10% per month would take 249 weeks, or 4.8 years. At this rate, I could go down to a millionth of a dose in 587 weeks, or 11.3 years.  

 

At some point it gets ridiculous.  At what point should I simply go cold turkey?

Thanks

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music321   
music321

My math was off.  The above is in months, not weeks.  I'm looking at half a decade to stop at 1/10 mg.

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AmyK   
AmyK

I am down to 0.24 mg zoloft. It seems easier to taper now. 1 mg to 0,6 was soo hard!

Anyway I will go further down, I still feel side effects and some wd symptoms.

I guess it's very individual.

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music321   
music321

What occurs to me is that if these drugs are active at concentrations of 1% their prescribed dosage, perhaps they should be prescribed starting at these very low dosages.  Then, I'm not really for their use at all after all that I've been through.

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AmyK   
AmyK

I agree with you. 50 mg was too much for me. I woke up like a zombie each day.

They should never be prescripted...

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Panicpax   
Panicpax

Now I'm stabilizing at 3.6mg of paxil and it took me 20 month to get here from 20mg on for a few years .

 

I will for the first time do a 12% taper each month since that's what my brain can handle.

 

But it does seem ridiculous to go down as far as 0.2mg ... but after a got an accumulation hit last week because I was going 15 to 20% monthly

( 3.4 so I upped it and am stabilizing nicely on 3.6)

 

I don't see it that ridiculous anymore... will take about another 2 years but I really don't care as long as life can be lived normally and functionally.

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KtKat   
KtKat

What occurs to me is that if these drugs are active at concentrations of 1% their prescribed dosage, perhaps they should be prescribed starting at these very low dosages.  Then, I'm not really for their use at all after all that I've been through.

 

I agree with you music321, the starter dose of escitalopram is 10mg, at which level you have 80% binding of chemical to the relevant receptor. Why can't they start your dosage at 5mg (which still has about 70% occupancy) and see what happens from there? Sure, you might end up having to wait another 6-8weeks and then updose, but surely that would reduce some of the side effects. I had horrible nausea and diarrhea for the first few weeks when I started on it. 

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Cipramillion   
Cipramillion

Im at 0.08 mg lexapro and still tapering. I actually felt worse after last 10% cut. When you go below the 0.5 border, its not possible to get accurate doses, even with liquid. But still better than jumping off.

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Cipramillion   
Cipramillion

My plan is to do one more cut, then evaluate response and heal for 4-8 weeks. Hopefully i can go the full distanse to zero then. Lexapro is a strong SSRI, so i will take no chances at this point. Then my last dose will be 0.04 mg. Anyone lower?

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erer   
erer

A question for those of you who have experience in slow tapering and reaching the dosage below 1 mg. (Or for those who have made plans for when they get there):

At some point it gets absurd. It is just mathematically inevitable. If we reduce 10% from the previous dosage, we will be tapering forever.

 

This is why I have created a tweaked schedule for myself where I've rounded up the amounts. That again means that after reaching 1 mg the reductions will be 0,9 mg to 0,8 to 0,7 etc. Jump from 0,2 mg to 0,1 will be a 50% reduction.

 

So far I've reduced by 8 and 9% and have reached 0,76 mg. My "tweaked" plan would require the next step to be 0,66 mg. Is that too radical in your opinion? What have you done or are planning to do when reaching such small amounts?

 

20597154_511943676692_1621442814402171880_n.jpg

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Madeleine   
Madeleine
2 hours ago, erer said:

A question for those of you who have experience in slow tapering and reaching the dosage below 1 mg. (Or for those who have made plans for when they get there):

At some point it gets absurd. It is just mathematically inevitable. If we reduce 10% from the previous dosage, we will be tapering forever.

 

This is why I have created a tweaked schedule for myself where I've rounded up the amounts. That again means that after reaching 1 mg the reductions will be 0,9 mg to 0,8 to 0,7 etc. Jump from 0,2 mg to 0,1 will be a 50% reduction.

 

So far I've reduced by 8 and 9% and have reached 0,76 mg. My "tweaked" plan would require the next step to be 0,66 mg. Is that too radical in your opinion? What have you done or are planning to do when reaching such small amounts?

 

20597154_511943676692_1621442814402171880_n.jpg

I don't have an answer and hope some replies soon as I'm interested in find out what to do too when I get lower done.   But, I am wondering: how are you feeling?  i.e. how has the taper been going? 

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erer   
erer
13 hours ago, Madeleine said:

I don't have an answer and hope some replies soon as I'm interested in find out what to do too when I get lower done.   But, I am wondering: how are you feeling?  i.e. how has the taper been going? 

 

So far I would have to say I mainly have the symptoms that derive in one way or the other from a CT over 2 years ago. The reductions I have made so far to this drug, Olansapine, have not brought up catastrophic symptoms (unlike the Cymbalta taper).

 

It seems to me that my AP taper has been very different from my previous AD taper that ended in catastrophe. In AD taper I got specific very strong and overwhelming symptoms after reducing, but now I really just don't even get strong symptoms that could be associated with the reductions. I mainly just have what I call residue symptoms from my CT over 2 years ago (my sh*tty baseline), but this is constant and has been getting better bit by bit regardless of the tapering.

I have been reducing by 8-9% a month and what I usually get is 3 nights of poor sleep and sometimes (which is the scariest) my akathisia acts up for a day or two (very rarely). But that only happened when I tried reducing after 3 weeks instead of 4.

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aberdeen   
aberdeen

By the end of my taper, below 1mg, at some point I started reducing by 0.1mg every 5 weeks. I did that until I was taking 0.1mg and then stopped. I didnt find my symptoms to be any different than all along to be honest. 

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erer   
erer
1 hour ago, aberdeen said:

By the end of my taper, below 1mg, at some point I started reducing by 0.1mg every 5 weeks. I did that until I was taking 0.1mg and then stopped. I didnt find my symptoms to be any different than all along to be honest. 

 

Thank you aberdeen, your input is very important to me. I am still going to be very careful and watch my symptoms, but I feel it is also important to be able to believe that there can be a positive scenario. (Have been reading lately about placebo, nocebo and the power of one's mind). So thank you for giving me an option to believe that there is a way.

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