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Micro-taper instead of 10% or 5% decreases

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Altostrata

A micro-taper is a way to go off psychiatric medications in a very gradual way that doesn't depend on the calculation of 10% decreases.

 

Often, micro-tapering isn't any faster in total than a 10% or 5% reduction, but for people whose nervous systems are exceptionally sensitive, it may be more tolerable than the relatively larger reductions.

 

To do this, you need to taking a liquid medication or one that comes in capsules filled with beads, such as Effexor XR or Cymbalta. The micro-taper method is particularly helpful in going off benzodiazepines, where people are often sensitive to minute changes in dosage.

 

The idea is you might be able to make smaller decreases more often. BUT -- don't go faster than your nervous system allows!

 

Micro-tapering does NOT mean making a reduction every day.

 

People who have tried a 10% or 5% reduction and already understand their withdrawal symptom pattern and nervous system tolerance for dosage changes are in a good position to try this. They may already have a feel for the amount of the micro-reduction, for example, 1 bead or .5mg.

 

A very sensitive person might want to make reductions of .01mg.

 

How to do a micro-taper

  • Decide on the amount of your micro-taper, for example, 1 bead of Cymbalta.

     

    If you have had problems with a 10% taper, the amount of your micro-taper will be much smaller than 10%. For example, if you find you can't reduce 10% from 25mg -- 2.5mg -- without withdrawal symptoms, your micro-taper would be a fraction of 2.5mg, such as .5mg.

  • Reduce your dose by the micro amount. Take this dose for a week.
  • If no withdrawal symptoms, you may be able to reduce by the micro amount more often, such as every 4 days. For most drugs, it takes about 4 days for a change to fully register. If you go faster than that, you might exceed your tolerance for dosage reduction and not know it until it's too late.
  • You may wish to hold on reduction ever so often, to allow your nervous system to rest and integrate at the reduced level of medication.
  • This may work fine for a while, then you might find you feel the micro decrease. This is a sign to either 1) make the micro decrease even more micro, or 2) you need longer holds between drops.
  • Keep a journal of your symptom pattern and dosage drops so you can see how the decreases are affecting you.
  • As with any tapering schedule, if withdrawal symptoms appear, slow your tapering or hold on the current dosage until the nervous system stabilizes.

     

    According to our member Rhi, she controls her micro-taper by "paying close attention to my withdrawal symptoms and holding longer whenever they seem to be ramping up at all.

     

    This requires being VERY attentive to your symptoms and I also recommend keeping a chart of dose changes versus symptoms. But I find that it allows me to adjust my taper quickly and subtly as needed."

Liquid solutions are helpful for micro-tapers because they enable very gradual, controlled tapering. Many drugs are available in liquid solution form, or they can be made into a liquid by a compounding pharmacy. Some drugs, such as Prozac, can be made into a solution with water at home. Use the Search box at the upper right for tips about tapering specific medications.

 

See also:

Making a liquid from a tablet or capsules .

Using a digital scale to measure doses.

Edited by scallywag
added links (liquid and scale)

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Altostrata

Reminder to everyone interested in micro-tapering:

 

If you want to try a micro-taper, I strongly recommend you find out your symptom pattern first.

  • Do NOT plan on reducing your dosage every day.
  • Wait at least 4-7 days after each of the first few reductions to see what happens.
  • Keep notes on paper about your dosage and symptom pattern -- this is important!
  • From your symptom pattern, you can figure out your tolerance, how fast you can go.
Even a reduction of one bead or one tenth of a milligram may be too much every day. Over a week or 10 days, this builds up to a large reduction in a short period of time. Do not take it for granted because a bead seems tiny, your nervous system won't notice the cumulative reduction.

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Rhiannon

I would add, start with smaller cuts at first, too.

 

And keep a journal of your dosages and your symptoms (ranking them on a numerical scale, like 1 to 5).

 

I know we are all so impatient to get off these drugs--I started my tapers WAY too fast, and paid for it!--it's hard to take it slow at the start. But it is SO worth it, because you can learn your own body's patterns of withdrawal and recovery, and you can adjust your taper to your own needs.

 

Once you have a sense of how your body's going to react to cuts, and how the withdrawal process unfolds for you over time, and how long you need to hold before you can cut again, you can adjust up the speed of your taper until you find the pace that gives you the optimal balance between tapering progress and minimizing withdrawal symptoms. And once you learn how your body reacts to tapering you can fine-tune your taper according to the demands of your life.

 

For example, if you have a special occasion coming up that you want to be feeling good for, you will know how long you need to hold your taper beforehand. Or, if you know you have a nice low-key stress-free time coming up and you want to push your taper a bit harder, you know how much you can get away with and how much lead time you can expect before the symptoms ramp up.

 

It's really worth taking the time to get to know your body's responses right up front, if you can summon the patience. Way better than doing what I did at first, pushing it too hard and then crashing and burning. Big ouch.

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Redeemed2012

With regards to this Micro Tapering method, are you guys referring to calculating the tiny cuts off of the original dose, or are you guys referring to tiny cuts off of each current dose? Thanks for your help in advance.

 

 

Redeemed

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Altostrata

We measure by tiny cuts off the most current dosage. If you're tapering by a steady amount such as 3%, the absolute amounts of the decreases would keep getting smaller.

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Jerome

I am microtapering Ativan at a 12.5 ug/day reduction rate. This rate will change as the taper changes. Although I do reduce my daily dose every day, which Alto does not recommend, it took some serious experimentation to dial in a daily reduction rate that works for me. Most of my daily dose is taken as 0.5 mg tablets; the use of a small amount of liquid lets me measure the cut with the required accuracy. I dose 3 X day and take make up doses in between. This may be why I don't experience IW sx. I take 1 less tablet than my daily dose calls for,  and make up the Ativan in that tablet with [a steadily decreasing amount of] Ativan in liquid form. This allows continuous gradual reduction without cuts in the usual sense. My w/d sx are minimal. Stress flares them up, so learning to deal with stress w/o good ol' chemical assistance is definitely part of my healing. Exercise and yoga/meditation seem to be very effective--when actually done.
 
Jerome

Edited by Petu
fixed text

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Altostrata

I am microtapering Ativan at a 12.5 ug/day reduction rate.....

Let us note that 12.5 ug means 12.5 micrograms or 0.0125 milligrams.

Edited by Petu
fixed text

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Rhiannon

I'd like to mention again the necessity of intermittent longer holds in a microtaper.

 

I have found that after doing three or four very small cuts I generally need to take a longer hold period (at least a couple of weeks, sometimes a month) to settle down. My taper might not be 100% typical (I'm tapering multiple meds at various rates so it's definitely not typical), but it seems like most folks I've worked with doing microtapers do need periodically to take longer holds. 

 

It's possible for even very small reductions to have a cumulative effect over time and to get ahead of our brain's ability to heal. It's hard to gauge; we have to listen carefully to our bodies.  

 

Not all withdrawal symptoms are experienced right away. The healing process is complex and it seems to have different stages which unfold out over a period of time.

 

You don't want to get ahead of that process and end up finding you've cut too much. Even with tiny cuts that can happen if you make them too often and you ignore or "push past" symptoms.

 

Learn your body's patterns and warning signs, and listen to them.

 

If you do that, I think a microtaper allows a level of responsiveness and sensitivity to tapering and withdrawal that can make a taper possible and tolerable even for people who are very sensitive to changes in psych meds. I love microtapering myself and wouldn't be able to do it any other way.

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Lexy

I have been microtapering effexor since January 2013 without much relief.  Is this because of the 50% cut I made in Oct 2012?  I became sensitive to any decrease/

I wasnt on this drug for long in the first place.

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Rhiannon

I'm currently tapering off Risperidone, which I've taken for 9 years. Even small steps such as 2% result in a great deal of bad withdrawal symptoms for me. Like sleeping worse, being more anxious, depressed, hopeless, restless, agitated, nervous, unable to concentrate, having suicidal thoughts, etc.etc. However, after days or weeks, these symptoms relieve and I feel way better than before.

To avoid these big amount of withdrawal symptoms, I once tried to micro taper every other day.

It was like Rhi mentioned, the withdrawal symptoms occured only several days after going to a lower dose. When I noticed that I've actually gone too fast and having too much symptoms, I already have tapered even more and then had trouble stabilizing.

Still I want to try micro-tapering again, in order to distribute the strong symptoms over the days. But first I have to find out a good taper rate.

 

From reading this (not knowing anything else about your history) it sounds like you may be cutting small amounts, but too fast. We can't always cut every day or every two days.

 

I know it's frustrating to go slow--believe me, I know! I'm terrible at patience! But it's really important to do that, especially at first.

 

I would try making a micro cut and waiting a full seven days to observe how symptoms come, when they appear, how fast they fade. If there are no symptoms after doing two cuts this way, I would then experiment with moving the cuts a little closer together, gradually. Keep a journal every day of what you cut and when. Note when symptoms appear, and when they do, look not only at your most recent cut, but at the pattern of how much you have been cutting how often for the previous weeks as well.

 

If you start slow and only gradually increase, you will be able to get a sense of what you can tolerate, and then you can design your taper in a way that works for you.

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nz11

Whats the viewoint on sa about how low one should go ie when should people jump off ...1mg? 0.5mg? 0.1mg?

Is there really any point in anything below 1mg? ...or are you finding people still struggling at that below 1mg dosage?

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Altostrata

The point at which people simply stop varies according to the individual. My recommendation is to go at least to less than a milligram before quitting.

 

There are a host of points in a milligram! In our Introductions topics, you can find people who are tapering by tenths or hundredths of a milligram. Again, this is individual.

 

Personally, I have had times when I tapered by hundredths of a milligram, my nervous system was so sensitive.

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Rhiannon

Whats the viewoint on sa about how low one should go ie when should people jump off ...1mg? 0.5mg? 0.1mg?

Is there really any point in anything below 1mg? ...or are you finding people still struggling at that below 1mg dosage?

 

Depends on the med and the person. I've only come all the way off one med, gabapentin. By the time I got to the end of my microtaper I was cutting by about 0.5 mg (half a milligram) at a time, so that's the amount I came off at. But gabapentin was originally prescribed for me at 1800 mg a day. Xanax, on the other hand, is usually prescribed in amounts like 0.25 to 1 mg total, so obviously you're going to be working with much smaller numbers with that one.

 

I think really you have to just decide based on how fast you've been able to taper so far. As usual, our bodies are the only real experts. If you're microtapering you'll probably have a pretty good sense of how much you can cut at a time, and I wouldn't come off at any dose higher than that amount. 

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indigo

I am down to 3.40 ml of prozac liquid.  Even micro tapers are now very hard .

My last micro drop was .04, after a one month hold, caused sadness and anxiety for weeks.

Rhiannon, you have always suggested longer holds. After my last micro drop I'm convinced

I need to stay at this dose until I've felt totally fine without symptoms for at least a month.

I feel emotionally exhausted. It's humbling.

Of course there is the nagging fear that I'll never feel fine again and this is as low as I'll be able to go.

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LexAnger

Indigo,

We hit the exactly same wall at the same time and similar dose doing micro tapering!

For the first time ever pre and post my experience with ssir, I suddenly have some depressing feeling at my last cut to 3.3 mg lex. started first with heartburn/ reflex which has been gone for one year without PPI (CT PPI One year ago without prob) after a silly big meal at a party last weekend.

 

It's very disappointing I still got hit with the super slow reduction and just one month after I started seeing some lights!

Has the new symptoms subsided for you? How bad are they? Mine is light, but still very hard to deal with on top of everything else. Interesting thing is, my other symptoms that have been always with me, mainly pain related allover, lessened quite a bit exact the time when the new sxs started, makes me thinking I'm at the dose of turning point with more WD than side effects.

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LexAnger

Oh, I understand slow taper won't guarantee symptom free, I wonder what we can expect and need to be prepared giving going super slow.

 

I would appreciate any ffedback from experienced members.

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ikam

I am preparing "mentally" for slow tapper...I am at present on 2.5mg...

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Lexy

Has anyone put a long hold on their micro tapers and then were able to resume decreasing with somewhat bigger cuts?

I have been struggling lately as I am down to 18.07mg of effexor. I am doing 3-5 % monthly fr the last couple months before that I was able to do 7% monthly.

I'm having a lot more zaps and even low grade fever that comes and goes. My doctor, who does believe in wd syndrome says that fever is from the chronic fatigue and muscle and joint pain.

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Altostrata

 

  • You may wish to hold on reduction ever so often, to allow your nervous system to rest and integrate at the reduced level of medication.
  • This may work fine for a while, then you might find you feel the micro decrease. This is a sign to either 1) make the micro decrease even more micro, or 2) you need longer holds between drops.

 

 

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KarenB

Just had a re-read of this thread to remind me why I'm doing what I'm doing... very helpful, thanks to all who've written above.  I think I have found a good tapering rate for me.  This month I made 4 weekly 0.4% cuts, and now I'm going to hold for a month.  I'm feeling pretty good, very minimal symptoms, almost even 'normal' sometimes ;)

 

I am somewhere around 133mg Effexor, so have a ways to go yet but I vastly prefer this way to the big (10% and 1%) cuts I did at first which made me feel awful most of the time.  

 

KarenB

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shelbytrev

Do you think it's possible to feel any different from just two days of taking one bead out? I'm thinking maybe I'm just having anxiety cause I know that I took the beads out ???? Allergies have been bad around here lately also. So it's hard for me to tell the difference. I also believe in the last couple months I have been experiencing withdrawal effects even though I wasn't tapering.

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Lexy

Sounds just like me. Do think it is eds. Just a bead gives me hella anxiety.

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KarenB

I notice a change from just taking two beads out - haven't tried just one.

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ppppp9

I tapered off Effexor XR completely 75mgs. over a 2 year period.  I never thought to count the beads, I just guesstimated and poured them out with each decrease.  Oddly enough, although I did that, I never felt any withdrawal symptoms or anxiety.  I was always able to remain calm even when I tapered to a tiny tiny amount.  When I finally discontinued, I felt great for about 3 months.  Then I hit a rough patch, something made me anxious and that made all my anxiety come back.  To boot, I even developed OCD symptoms which I never knew were there.  Don't know if that was withdrawal symptoms from discontinuing Effexor or that maybe I'm an anxious person.  I had been on Effexor XR for over 12 years, always at 75mgs.

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Rhiannon

I tapered off Effexor XR completely 75mgs. over a 2 year period.  I never thought to count the beads, I just guesstimated and poured them out with each decrease.  Oddly enough, although I did that, I never felt any withdrawal symptoms or anxiety.  I was always able to remain calm even when I tapered to a tiny tiny amount.  When I finally discontinued, I felt great for about 3 months.  Then I hit a rough patch, something made me anxious and that made all my anxiety come back.  To boot, I even developed OCD symptoms which I never knew were there.  Don't know if that was withdrawal symptoms from discontinuing Effexor or that maybe I'm an anxious person.  I had been on Effexor XR for over 12 years, always at 75mgs.

It's actually pretty common for people to hit a rough patch three to six months after coming off an AD. Don't know why.

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ppppp9

Thank you Rhiannon.  I don't know why this happened to me.  I found myself worrying about something to the point it became an obsession and then my anxiety just shot up and got more intense with each day.  I don't know why that happened.  Maybe I should have rode it out for several months.  Tried some natural supplements for anxiety and that's helped.  Now, I've reinstated Effexor but only about 5-7 beads.  I feel calm again and my obsessive quality that appeared out of nowhere is gone.  What's that all about?  What should I have done instead of reinstating?  I did so well cause I tapered over 2 years to virtually nothing and felt great for three months after.

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SkyBlue

I'm wondering how I can begin a micro taper on 1.1 mg (.55 ml) of Paxil. 

 

The lines on the syringe (tiniest syringe they had at the pharmacy) are just microscopic.

 

For my next drop I'd like to try instead of 10% all at once, 2.5 + 2.5 + 2.5 + 2.5. 

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mammaP

Hi Skyblue, I bought some 0.5ml syringes online and took off the needles and covers with a pair of pliers, no need to expose the needles. Ebay have them but didn't find many on Amazon. They are perfect for the lower doses.  You could maybe dilute the liquid to make it easier to measure if it becomes too hard to measure the tiny amounts. 

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Oneday77

Hi!

I am doing a micro-taper of Cymbalta. I am taking off 1% ever month. This is what works for me. I don't care how long it will take. Every morning is a little victory when I empty beads from the capsule. I have played with the timing of my medication as well. If I take it around 7 am, I am good all day until 7 pm. Then I feel a little nauseous. At least it happens when I am done work and ready to slow down my day and Kids are in bed. I have been on Cymbalta for 10 years, I can handle another year or two. :) I am also seeing a psychologist and a naturopath to help me. The interesting thing is that even though I have lowered my dose, I don't feel worst emotionally than I did on the full dose. I feel the same, and some days I feel better. The Cymbalta was only preventing me from crying and feeling aware of my emotions. I now cry a little more and I seem morr able to see my emotions for what they are. They are not me. I still have a long way to go, but I feel more in control. This site has given me better information and support than any doctors or books could. Thanks!

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CaptainJackSparrow

Not everyone can do the liquid method, it's too complicated honestly, are there other solutions instead? simple ones?

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SkyBlue

Hi everyone! I got a 0.5 ml syringe! 

 

I called tons of pharmacies near me -- even a vet's office! (They had them, but wouldn't 

let me buy one!!) No one else had them.

 

I finally located one at a compounding pharmacy 20 miles from me. They just gave it

to me (like Alto mentioned above). I was sooo happy and thanked the lady profusely!!! Lol

 

It's so cute and tiny! It really lets me see the tiny gradations I will need to do 2.5% cuts. 

 

Thanks again to all, esp. Alto and Mamma P!

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SkyBlue

Not everyone can do the liquid method, it's too complicated honestly, are there other solutions instead? simple ones?

 Captain Jack, there is the weighing method. People use a super-sensitive scale to get the tiny dosage decreases they need.

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Icandothis

Hello!

I am currently tapering liquid fluoxetine (I was originally on the pill form but switched to liquid when starting the tapering). I find it has been easier to manage for me than trying to cut a pill accurately. I am now at .54ml and am concerned about when I drop down very low as I am using a 1ml syringe but I am very excited that there is a .5ml one! Thank you Skyblue for giving me hope! I have been making 5% decreases out of concern that if I drop a larger amount at these lower doses I will have a hard time. So now I will have to be on the look out for that syringe :)

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Altostrata

You can dilute the liquid drug more so you can measure small amounts with the same syringe.

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