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Rhiannon

Rhi's "Start Small, Listen to Your Body" Taper Plan

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Rhiannon

As you can imagine, I've conversed with tons of people who were wondering how to taper. Usually they come to me asking for a really specific taper schedule--cut this much, hold this many days or weeks, cut this much, hold this many et cetera.  

 

And generally when we start tapering, we all start with the expectation that we can hold our taper and our bodies to a calendar schedule.

 

Unfortunately, bodies were invented long before calendars, and healing doesn't follow a numerical schedule. (Just try telling a broken bone that it has to heal exactly 10% every two weeks.)

 

And what I see is that the people who do best with their tapers are the ones who listen to and follow their bodies' internal wisdom, rather than some external notion of a "correct taper" or some schedule given to them by someone outside.

 

Another thing I see that's practically universal is that people want to start with bigger cuts and shorter holds. We all want off these meds as fast as possible. Unfortunately, if you start out too aggressively, what usually happens is people crash and burn, suffer a lot, end up having to reinstate and then wait a long time to stabilize before they can begin to taper again.  And it actually ends up taking longer.

 

So these days I end up giving this same advice over and over. And I decided to just copy it and paste it and put it here so I can just refer people to it rather than retyping it every time.

 

Rhi's General Taper How-To Advice:

 

Start small and conservative. Start with a small cut and a long hold. Don't try to follow a calendar schedule; follow your body's schedule instead, by observing your own symptoms. 

 

Keep a daily journal of symptoms (ranking them on a numerical scale of 1 to 5 or something like that). Don't trust yourself to remember the way your symptoms wax and wane--the drugs and the withdrawal actually interfere with our ability to reliably perceive patterns. (Trust me on this.  It's pretty much universal. Your mind will lie to you.)

 

Write it down each day and you'll see the patterns emerge.

 

Do a few small cuts and long holds this way until you have a feel for how your body is going to respond to cuts and how the withdrawal symptoms are going to unfold and play out and resolve for you.

 

There are often delayed effects from a cut that don't show up right away, and if you taper too fast, those "lag time" symptoms can add up and hit hard, and it's too late to slow down because you already made the cuts. So take it slow with long holds, and allow the full pattern to play out, so that you become familiar with it.

 

Collect data this way for two or three months. Once you have a track record, you can then decide if you want to try larger cuts and/or shorter holds. 

 

Experiment conservatively until you find your optimal rate of taper.

 

This way you will become the expert on your own withdrawal process and you'll be able to tailor it to your own needs and your own life changes.

 

Speaking from experience--both my own and that of many other people--not only will you actually be able to get off your meds just as fast this way as you would if you tried a fast, aggressive taper (because you'll be less likely to crash, get all messed up, and have to reinstate or hold for way long, or maybe end up on even more meds you had to add, et cetera)--you will also save yourself and your loved ones a lot of suffering.

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Nikki

Someone once told me to "throw out the calendar".  I have an issue with time.

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Rhiannon

Rhi, just one question. Do many people find that a taper rate that was once optimal can become sub-optimal down the track? Just wondering if that's something people should be alert to?

 

For me, the optimal rate of taper has varied a lot, depending on my overall health, stress levels, sleep quality, and factors I haven't been able to necessarily figure out, hormones and stuff.  That's why I go slow and stay tuned in to my symptoms, so I can hold whenever things seem to be ramping up. I still screw it up from time to time but at worst I just get into a really bad wave and it passes if I hold long enough (like two months, this last time).

 

I think a lot of other people have found this too. Especially stress levels. 

 

Plus I think a lot of people find they have to slow down at the lower doses, as well (although that may be partly because 10% cuts are so small when the dose is small, it's easy to overshoot if you don't actually do the math).

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mammaP

 

I would just like to point out that when I missed a dose of effexor I would get hypermania, right from the start of taking it.It can happen when tapering and easily be misinterpreted as feeling better and lead to another cut too soon when it is actually a withdrawal symptom. I cut too soon at first but soon discovered I had to wait until that passed and stabilised before the next cut.Just something to be aware of.

MammaP,This is a great point. I think you meant "hypOmania"..? This is exactly what happened to me. I knew I should taper, but had not found this or similar websites. I cut Pristiq too rapidly, had some anxiety and was definitely hypomanic which, for me, meant I could keep up with other peoples' energy level and activities. For once, I had ENERGY, some appetite, slight sex drive (as compared to none). Then, months after finishing the "taper", I crashed in a big way. :(

 

Yes Barb, hypOmania......I always get that wrong, lol.  I was delighted when I thought I was better so quick, soon came down to earth though! The crash is horrific and devastating  :(

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Rhiannon

I get hypomanic with cuts sometimes too. I think that's a good point, to be aware that withdrawal can manifest in ways that don't always fit our pictures of "feeling bad." When that happens you have to stop and hold same as with any other withdrawal ramp-up.

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Lexy

When tapering and the decrements are so small as in 1-2% monthly, are waves or WDs less intense?

I've been micro tapering since the summer i am still getting WDs.

 

From Jan to May of this year I was decreasing by 5-10% and symptoms were nausea, dizziness etc.

Now I have mood swings, anxiety on some days, huge headaches.

 

I don't know whether to go back to 5-10% cuts because I can dealnwith nausea and dizziness more than these latter symptoms.

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chicken

Rhi,

You mentioned in another thread about getting to a very low dose and never getting off, let's say for example .3mg.

 

How would this play out if you had to spend an extended time in the hospital or nursing home for another reason. I found that they will want to give you what is prescribed on the bottle rather than what you've tapered down to. This happended to me when I went in the crisis center. I had to give them my meds and they admistered them. I tried to explain that the doctor had tapered me down and was letting me take less than what was written on the bottle. They tried to say that I have to take what is written on the bottle.

 

Anyway, what if you decide to stay on the a small dose and never get off and you end up in a nursing home. They are just going to give you your full dose no matter what. This is why I think it is better to try to get completely off if you can.

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mammaP

I don't think Rhi is suggesting that people just stay on Chicken, like the doctors do, it is in case some people just can't get

off that last teeny bit. It is the same as you say, it is definitely best to get off if you can.

 

I agree with you that it would be difficult for people who go into hospital or nursing homes, especially psychiatric hospitals

and we hope that doctors would respect patients rights. I am going into hospital for surgery next month and will take my 

effexor beads with me but will not be handing them over! I don't have them on prescription now and as far as the gp is

concerned I am off it. I have enough to last me my lifetime at the rate I'm on so it isn't much of a problem. 

Last time I was in hospital I was taking half the prescribed dose and just split the capsule in the bathroom, where there's a will 

there's a way  ;)

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Meimeiquest

"Real" medical facilities can't give drugs based on labels, it has to be specifically ordered by someone licensed to prescribe. Doctors etc. can order "patient may self-administer xyz." And pharmacists can find a way to "whip up" the doctor's orders. But you know the country song "All I Want is Done"? We could all dance to that!

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Rhiannon

MammaP thanks for digging this up! I write stuff and then lose it in the mists of forum time. I stuck a link to it in the Best Of thread in Off Topic so hopefully I will be able to find it in the future.

 

And yes what everyone said about getting off meds. Of course ideally I hope to get off everything, but if I can't I'm still better off at low doses. I think doctors can write prescriptions for any dose to be compounded, the important thing would be to make sure your family or whoever's going to be looking after you (if you can't yourself) knows what your doses are. I've been thinking of getting a MedicAlert bracelet and having my doses listed there, just haven't gotten around to it yet.

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nz11

This is brilliant advise yes i totally agree 'start slow is the way to go' as in 2.5 % say and hold. And watch for a good 6 -8 weeks to see if the coast is clear.

Yep wdl symptoms are delayed  and cumulative imo so i'm on the same page here.

And yes i kept a journal...for just over two years. Journal is a great idea too.

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Songbird

Do many people find that a taper rate that was once optimal can become sub-optimal down the track? Just wondering if that's something people should be alert to?

 

From what I've seen, some people seem to be able to do the regular schedule taper no problem, others seem to crash suddenly at a certain dose.  I believe that for many people, some dose ranges can be more difficult than others, so tapering rates can be changed to suit.  For example, I never had any trouble getting down to 10mg from higher doses, I could do big drops down no problem.  Under about 8mg it got much harder and I had to do much smaller drops with much longer holds until I was doing really tiny drops of 0.05mg.  Since I got under 4 mg things have begun to get a little bit easier and I've been able to taper a little bit faster.  Basically I adjust based on how things are going for me.  If things become difficult I change to smaller drops, if things get easier I'll try a slightly bigger drop (I mean slightly, they are still small drops).  Each time I hold until I feel stable and ready for the next drop, no matter how long it takes.  There were some years I only did a couple of drops because it took me many months to stabilise and I didn't dare drop again while feeling so unstable.

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Rhiannon

Yep, that's why I say your body is the only expert and true guru when it comes to tapering. Just be careful to go slow enough that if your body says "enough!" you haven't already gotten too far ahead of its ability to adapt and recover.

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dalsaan

Rhi you once posted a link to a site where you can by small numbers of pipettes for microtapering.   I cant find the link, do you have it handy and do you have any recommendations on what to buy?   I want to be able to drop very small amounts like .05 ml if possible

 

D

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Songbird

You can do 0.05ml drops with a 1ml syringe, that's what I've been doing.  Some pharmacies stock 1ml syringes, so when I find them I usually buy several at a time as eventually the numbers wear off.

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Rhiannon

You can also dilute the meds more so you can get the same dose with a bigger volume. (Like if you have twice as much total solution, you'd have the same amount in 0.1 mL that you would get in 0.05 mL if it was more concentrated.)

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Brighid

Wow, Songbird, your eyes are better than mine! One drop on a 1 ml syringe is as small as I can manage to measure. Rhi, do you happen to know whether it's possible to dilute a compounded liquid for the purpose of measuring smaller increments? I've asked a couple of pharmacists and gotten different answers. 

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Rhiannon

Brighid, I am assuming it is. My PA (who is kind of an idiot) is insisting on putting me onto liquid diazepam instead of the tablets, so I'll be experimenting with this myself very soon (like, this week).  

 

But the pharmacist's knowledge trumps mine on this one. Maybe you should ask a few more and go with the majority vote.

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