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After reinstating or updosing, how long to stabilize?

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Newbeginning   
Newbeginning

Has anyone become unstable after a long (4 month) hold? How does reinstating work in that case? I was stable for months and holding because I was trying supplements. I got off all supplements 2 weeks ago, but there's been minimal improvement only. My next option is reinstating a bit.

 

I'm worried that if I reinstate after a long hold, I might destabilize my system and/or make future tapers harder.

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reachingforthestars   
reachingforthestars

I updosed after holding about a month from 4mg to 5mg and I had back reaction to it(akathisia, insomnia ect.). I also updosed from 2.6mg to 2.8mg after holding a week and had back reaction (akathisia). I never tried to hold for 4 days to stabilize and I think it is dangerous to try to hold if you get bad reaction. Also I think that there cannot be 4 days rule since different drugs have different half lives. I think that bad reaction means serotonin syndrome since the symptoms are so alike. Maybe receptors have become more sensitive and that's why even little updosing means big stimulation in the brain?

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Newbeginning   
Newbeginning

On the first instance of updosing, perhaps it was too much of an increase? When you had been holding for a month, I assumed you were in withdrawal?
 
On the second updosing, you didn't increase a lot, but I wonder how you were before that? Looking at your signature, you've been going rather fast. If you've been having withdrawal and kept cutting, your reactions to updosing may just be the same withdrawal that you had before, which the reinstatement didn't help. Sometimes if we get very unstable, reinstating doesn't work or can make us worse.
 
In my case, I've updosed several times and it always helped me stabilize. However, I never had withdrawal without cutting. It's been 4 months on the same dose so I'm not sure how my body will react if I updose. I don't even understand why I'm having withdrawal after 4 months of being stable right after another updose. My last change was an updose, not a cut! And it was over 5 months ago. I've been stable for 3 months and the last month had issues.

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reachingforthestars   
reachingforthestars

I know the difference between Wd symptoms and bad reaction. It is very clear to me since I know my body and they are very different kind of symtoms. Also the bad reaction is immediate akathisia after 1 or 2 hours after the dose of SSRI. I never have had akahisia as WD symptom.

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Newbeginning   
Newbeginning

I understand. It can also be a side effect of the med, which would show at higher doses. I'm not saying it was not a reaction to updosing. I just thought it could be other things too.

 

When that happened to you, I assume you decreased and the reaction resolved. But what about the withdrawal symptoms that you were trying to address with the updose? What happened to those symptoms when you updosed and then decreased again?

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reachingforthestars   
reachingforthestars

I didn't have much other WD symptoms than extreme muscle weakness. At one point I couldn't get out house because of the muscle weakness. Mentally I was very emotional and crying and laughing a lot and it felt good to feel again so much. There were some minor other physical symptoms but nothing bigger except that weakness. I was sleeping a lot like 14 hours a day and i was very relaxed, but due to weakness i wanted to try updosing...

 

Updosing made me extremely agitated added insomnia alkathisia and anhedonia and didn't help with muscle weakness at all. It helped when I reduced my dose to previous and akathisia lifted but anhedonia is still there and my sleep is still lighter that before updosing. 

 

Very very slowly muscle weakness has alleviated a lot and now i can walk 1 hour a day.

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Newbeginning   
Newbeginning

I see. So for you updosing led to bad results and some of those bad symptoms have not resolved completely even months later. That scares me :(

 

Was the weakness there at all before you started tapering (and got worse when tapering)?

 

The times when I updosed I had unbearable symptoms like bad anxiety that lasted months, and the updosing helped. But right now the situation is more uncertain.

 

Thanks for sharing your experiences. I appreciate it :)

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reachingforthestars   
reachingforthestars

No, before tapering I was in very good shape physically, athletic swimming and jogging.

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brassmonkey   
brassmonkey

Serotonin Syndrome is a very serious condition caused by toxic level of serotonin in the brain.  It is NOT caused by a small updose when a person is taking a minuscule dose. Because of the nature of the drugs WD symptoms, side effects and serotonin syndrome will have some things in common, but WD symptoms and side effects are not serotonin syndrome.

 

Half life is only one small factor in determining blood level steady state.  The 4 day rule takes into account half life, absorption rates, metabolic rates, dosing schedule, the aggregate experience of thousands of case histories and many other factors. After an increase in dosage it can take several weeks to many months to stabilize. During that time it is recommended that a person not change dose until they have stabilized. To do so increases the risk of further destabilization.  Also note that stabilization does not mean symptom free.  It means that the symptoms have evened out to a consistent level with no big swings either direction.

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Newbeginning   
Newbeginning

Serotonin Syndrome is a very serious condition caused by toxic level of serotonin in the brain.  It is NOT caused by a small updose when a person is taking a minuscule dose. Because of the nature of the drugs WD symptoms, side effects and serotonin syndrome will have some things in common, but WD symptoms and side effects are not serotonin syndrome.

 

Half life is only one small factor in determining blood level steady state.  The 4 day rule takes into account half life, absorption rates, metabolic rates, dosing schedule, the aggregate experience of thousands of case histories and many other factors. After an increase in dosage it can take several weeks to many months to stabilize. During that time it is recommended that a person not change dose until they have stabilized. To do so increases the risk of further destabilization.  Also note that stabilization does not mean symptom free.  It means that the symptoms have evened out to a consistent level with no big swings either direction.

 

 

Brass,

 

If you were stable after a several month hold, can you still benefit from updosing, or is it a bad idea?

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brassmonkey   
brassmonkey

If you're stable then why would you want to be updosing?

 

"My last change was an updose, not a cut! And it was over 5 months ago. I've been stable for 3 months and the last month had issues."

 

If your symptoms are starting to kick up after several months of stability, that would indicate the beginnings of a tolerance issue and the best thing to do would be starting a slow gentle taper. Up dosing would just add fuel to the tolerance issue.  It's counter intuitive but the best way out of tolerance is to decrease.

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Newbeginning   
Newbeginning

If you're stable then why would you want to be updosing?

 

"My last change was an updose, not a cut! And it was over 5 months ago. I've been stable for 3 months and the last month had issues."

 

If your symptoms are starting to kick up after several months of stability, that would indicate the beginnings of a tolerance issue and the best thing to do would be starting a slow gentle taper. Up dosing would just add fuel to the tolerance issue.  It's counter intuitive but the best way out of tolerance is to decrease.

 

I thought about that, but some of the other moderators don't believe in "tolerance withdrawal". They believe if this is withdrawal, then cutting more will cause more instability.

 

If I don't stabilize within a week or two, I'll try cutting a little. If I get worse then will take it from there.

 

Thanks for the advise!

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reachingforthestars   
reachingforthestars

Serotonin Syndrome is a very serious condition caused by toxic level of serotonin in the brain.  It is NOT caused by a small updose when a person is taking a minuscule dose. Because of the nature of the drugs WD symptoms, side effects and serotonin syndrome will have some things in common, but WD symptoms and side effects are not serotonin syndrome.

 

Half life is only one small factor in determining blood level steady state.  The 4 day rule takes into account half life, absorption rates, metabolic rates, dosing schedule, the aggregate experience of thousands of case histories and many other factors. After an increase in dosage it can take several weeks to many months to stabilize. During that time it is recommended that a person not change dose until they have stabilized. To do so increases the risk of further destabilization.  Also note that stabilization does not mean symptom free.  It means that the symptoms have evened out to a consistent level with no big swings either direction.

 

"Extremely high levels of serotonin can cause a condition known as serotonin syndrome, with toxic and potentially fatal effects. In practice, such toxic levels are essentially impossible to reach through an overdose of a single antidepressant drug, but require a combination of serotonergic agents, such as an SSRI with an MAOI.[67] The intensity of the symptoms of serotonin syndrome vary over a wide spectrum, and the milder forms are seen even at nontoxic levels."

 

So the intensity of serotonin syndrome can vary. I also read that it is impossible to test serotonin syndrome anyway(like take labs) so it only can be pointed out from symptoms(agitation, akathasia, imsomnia ect.). If I understood correctly it all depend from receptors and how sensitive they are. When we start to taper it is impossible to know what kind of changes is happening to our receptors. If we start getting more and more emotions it sounds to me like receptors are waking up and becoming more sensitive  so if you in that condition updose the stimulus can be so much bigger than in previous state where the receptors have been more numbed and you end up on toxic levels of serotonin. 

 

This is what mm100 wrote in an other thread:

 

"it seems to me that the problems may start due to the UPREGULATION of the serotonin receptors after discontinuing the drug, and this is also why taking the drug again will not help as the serotonin system is far too sensitized (upregulated)"

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Newbeginning   
Newbeginning

 

Serotonin Syndrome is a very serious condition caused by toxic level of serotonin in the brain.  It is NOT caused by a small updose when a person is taking a minuscule dose. Because of the nature of the drugs WD symptoms, side effects and serotonin syndrome will have some things in common, but WD symptoms and side effects are not serotonin syndrome.

 

Half life is only one small factor in determining blood level steady state.  The 4 day rule takes into account half life, absorption rates, metabolic rates, dosing schedule, the aggregate experience of thousands of case histories and many other factors. After an increase in dosage it can take several weeks to many months to stabilize. During that time it is recommended that a person not change dose until they have stabilized. To do so increases the risk of further destabilization.  Also note that stabilization does not mean symptom free.  It means that the symptoms have evened out to a consistent level with no big swings either direction.

 

"Extremely high levels of serotonin can cause a condition known as serotonin syndrome, with toxic and potentially fatal effects. In practice, such toxic levels are essentially impossible to reach through an overdose of a single antidepressant drug, but require a combination of serotonergic agents, such as an SSRI with an MAOI.[67] The intensity of the symptoms of serotonin syndrome vary over a wide spectrum, and the milder forms are seen even at nontoxic levels."

 

So the intensity of serotonin syndrome can vary. I also read that it is impossible to test serotonin syndrome anyway(like take labs) so it only can be pointed out from symptoms(agitation, akathasia, imsomnia ect.). If I understood correctly it all depend from receptors and how sensitive they are. When we start to taper it is impossible to know what kind of changes is happening to our receptors. If we start getting more and more emotions it sounds to me like receptors are waking up and becoming more sensitive  so if you in that condition updose the stimulus can be so much bigger than in previous state where the receptors have been more numbed and you end up on toxic levels of serotonin. 

 

This is what mm100 wrote in an other thread:

 

"it seems to me that the problems may start due to the UPREGULATION of the serotonin receptors after discontinuing the drug, and this is also why taking the drug again will not help as the serotonin system is far too sensitized (upregula

 

I didn't know there were different degrees of Serotonin Syndrome. Since Serotonin can't be measured reliably, it is virtually impossible to differentiate an adverse reaction to an updose/reinstatement from mild Serotonin Syndrome, if the symptoms of the reaction mimic Serotonin Syndrome.

 

I don't think one can get Serotonin Syndrome at the low doses we are on when tapering. Even if the receptors are upregulating, if you didn't get Serotonin Syndrome on the full dose before any of your receptors were downregulated, you shouldn't get it at lower doses or with half of your receptors upregulated again.

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reachingforthestars   
reachingforthestars

I know that my conclusions are only speculations since no one knows what really is happening in our brains and to our receptors during taper and during withdrawal. I believe that my receptors have changed so much from what they used to be before ten years on SSRI that it is now possible for me to get serotonin toxicity on lower doses. For example in insulin resistance it doesn't matter are the insulin levels normal it only matters are the insulin receptors sensitive enough to insulin. But if the insulin receptors are sensitive then you can get easily poisoning even from a little too high level of insulin. So in a way I think that SSRI can make serotonin resistant (serotonin) receptors and nothing happens even on high doses (except treatment resistant depression eventually).

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LexAnger   
LexAnger

I agree with RFTS from first hand experience about how the body reacts to these drugs after a bad reaction, even I don't know much about the science behind it. I never had problems taking lexapro at high doses until lately My body feels the poison effects of even a tiny drop. The whole situation changed completely. It doesn't matter what we call it, it's very true indeed.

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woof   
woof

You need to let your nervous system stabilize after reinstating. How long this might take depends on how long you've been off the drug and other factors. If you were off only a couple of days, you might stabilize for a month before trying to taper. If you've been off longer, to be safe, you should give your nervous system longer to stabilize, even if symptoms go away right away. If you've been off months, it might take months before you stabilize. Do not attempt to taper again until you feel symptom-free. (Cold turkey off another psych drug simultaneously compounds the situation.)

Hello Alto,

 

Thank you so very much for creating this site.  BTW, I actually grew up in SF and went to Woodrow Wilson High on Mansell, but I think it's closed now.

 

This statement above is such a great and very important piece of information. 

 

I was wondering if you think this post or something paraphrasing it may be appropriate to add to the first page of the Forum on tapering, where reinstatement is discussed in some detail.

 

I personally was pretty frantic when I first got to SA and didn't know my way around and has so much vital information, so I initially just read the Forums and did not see the post above until a few weeks ago.

 

Just my 2 cents,

You all are the best,

 

Most Respectfully and most Sincerely,

Woof

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woof   
woof

You need to let your nervous system stabilize after reinstating. How long this might take depends on how long you've been off the drug and other factors. If you were off only a couple of days, you might stabilize for a month before trying to taper. If you've been off longer, to be safe, you should give your nervous system longer to stabilize, even if symptoms go away right away. If you've been off months, it might take months before you stabilize. Do not attempt to taper again until you feel symptom-free. (Cold turkey off another psych drug simultaneously compounds the situation.)

If one did not have problems with the AD in the first place.  Tapering off them may not be the best choice for that person.  My situation is admittedly a bit odd in that I just wanted off of all meds, because I thought it was a good thing.

 

Please see my intro below.  Hopefully this can be of some help to someone in a situation like myself. 

 

For over 10 years I never experienced any problems with 20mg/d Cymbalta, It actually helped my sleep.  I wish I never started it for my neck pain, but that is way in the past.  I arrogantly just wanted to get off of all meds.

 

It's been 4 weeks now since I fully updosed to 20mg/d Cymbalta, after 3, 10% cuts.  The first cut was good as my AM anxiety immediately went away, so I thought that tapering was right for me.

 

Now I believe Alto's words above are extremely wise and that the anxiety and insomnia would have resolved, given a few more months at my reinstated dose of 20mg/d; as is empirically evidenced by my current state.

 

I was so scared to updose by 41 beads, but I did have confidence in the 4 doctors I consulted with and they all independently concurred with the action I should take - take the full 20mg pill.

 

One of these MDs is one of the 3 most cited MD's on this site, as well as within the healthcare community. 

 

While 41 beads sounds like a lot, if you look at the exponential activity curve (which these MDs were all well aware of) in combination with my dose and the fact that I had had no problems with Cymbalta in the first place,  I took their advice.

 

With the exception of my 1-3/10 tinnitus all of my sxs have resolved at this point. 

 

All of my sx's just got better and better after I updosed to my original 20mg/d level.

 

After a full year my sleep finally has come back, anxiety is gone, appetite is great, BM's are normal, I can watch sports or anything I want on TV again and Anhedonia is gone :)

 

Unfortunately, now I have to taper off of 25mg/d of Valium which I was maintaining as I was tapering, but at least my mind seems quite a bit more stabilized.

 

I will be tapering slowly off of the Valium after about another month or so of stabilization.

 

Everyone on this site has been wonderful to me and I have learned so very much from all of you, this is without question the best online site. 

 

I just hope that this post may help others. 

 

Warmest Regards,

Woof :)  

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powerback   
powerback

Hi is there anyone out there that got relief from horrendous anxiety/panic attacks , depression by up dosing after 2 years of halving a dose, I'm on 37.5 venlafaxine and it's pretty bad ,I'm extremely desperate .

I have to say this but ide triple by dose just for relief ,I can't function at all

Respect PB

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woof   
woof

Is there a consensus on the time limititations on reinstatement or updosing after destabilization; per others who are also knowledgeable on these issues (eg Dr. Healy)?

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Zzann   
Zzann
14 hours ago, woof said:

Is there a consensus on the time limititations on reinstatement or updosing after destabilization; per others who are also knowledgeable on these issues (eg Dr. Healy)?

Hi Woof, I do not know you'd have to Google your above question and I don't know which Doctor Healy your referring too sorry. All I do know is no one really knows even the drug companies that manufacture these chemicals don't know how these drugs really work its all very sketchy, but personally I would rather take the word of people that have actually been through this experience their than some Doctors 'theory' that's never taken any of these drugs.

 

It was Doctors ''theories'' misdiagnosis from the very beginning before any drugs, then beyond that ruing my life for the last 36 year's . Take Benzos for instance they were actually looking for a new antibiotic but found the side effects, sedation, and many other side effects then packaged Benzos as a cure all for sleep, anxiety, stress, grief, fits etc. But the same drug can actually cause all the stuff its prescribed for and are also now listed as side effects and withdrwal effects on the new ''Patient leaflet' that's suddenly turned up in my latest batch of Diazepam  it look as if the drug companies are trying to cover their arse by now producing a ''warning'' about a LOT more ''side effects and withdrawal symptoms than they have for many year's previously

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