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Altostrata

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

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Altostrata   
Altostrata

I'm going to post this here so everyone can see it.
 
Our basic rules of succeeding with tapering off psychiatric drugs or recovering from withdrawal syndrome are the rules of 3KIS: Keep it simple. Keep it slow. Keep it stable.
 
1. Keep it simple.
 
When the body reacts, often it's difficult to tell what the cause might be. When you're tapering or trying supplements or other treatments, keeping it simple helps reduce confusion during trial-and-error. Keeping it simple minimize confounding factors. For example:
 
1.a. Do not CHANGE the dosage of more than one drug or supplement at a time.
When you change 2 or more drugs at once and you get a bad reaction, you won't know which drug is causing it.
 
1.b. Do not ADD more than one drug or supplement at a time.
When you add more than one thing at a time -- or, worse, throw the kitchen sink into some kind of cocktail -- and you get a bad reaction, you won't have any idea what to do. Should you drop one thing or all of them?
 
This is also true of mixed supplements, supplements that contain more than one ingredient. It's better to try one ingredient at a time to see how you react.
 
2. Keep it slow.
 
Many people become very sensitive to drugs and supplements after they've experienced withdrawal symptoms for even a short time. Do not count on taking the big risks you used to take. Make changes slowly.
 
Introducing a drug or supplement or changing a dosage very gradually gives you the ability to sample how it might affect you before you go too far.
 
A big dose or big change probably will cause a worse bad reaction than a very small dose or change. You can injure your nervous system pretty badly with a big change -- it might take you months or years to feel better.
 
For example:
 
2.a. If you are tapering, we recommend a 10% reduction every month, based on the LAST dosage. (The amount of the reduction keeps getting smaller. Read this explanation: Why taper by 10% of my dosage?
 
2.b. Do not expect to feel better immediately. There are no silver bullets for withdrawal syndrome. There is no pill of any kind that will immediately put you back to normal. If you make a good change, the effect is likely to be slight at first. Be patient. Read this: What is withdrawal syndrome?
 
2.c. Do not jump around in dosage. For most drugs, it takes about 4 days for the change to fully register in your system. Unless you have an IMMEDIATE bad reaction, wait at least 4-7 days to see how the change affects you. (If you have an immediate bad reaction, go back to the dosage you were taking before.)  See steady state graph for Cymbalta.
 
Since withdrawal symptoms ordinarily fluctuate, you might have hours or days here and there when you don't feel well. One episode does not a pattern make. Do not panic and throw in another drug or supplement. Keep notes on paper of your daily symptom pattern. If you feel worse and worse over a week, the change was not a good one. It may be the decrease or increase was too large. Rather than jumping around in dosage, make an adjustment half-way.
 
2.d. Be patient, recovery is inconsistent and gradual. The nervous system is very complicated. It can repair itself, but it takes time to do this. In the meantime, you may experience The Windows and Waves Pattern of Recovery
 
3. Keep it stable.
 
The nervous system is delicate and very complicated. Normally, the autonomic system runs your body with numerous checks and balances, constantly gauging what hormones and transmitters need to be increased and which need to be decreased. Its job is to keep your body stable, at a tolerable temperature range, with everything running smoothly.
 
Psychiatric drugs interfere with the entire nervous system, not just the brain. This is why changing dosage of just one drug can affect your eyesight, your digestion, and your sleep. Taking psychiatric drugs affects the functions of the nervous system.
 
The nervous system, which works so hard to keep your body running smoothly, thrives on stability. When you take a psychiatric drug over a period of time (usually a month or more), your body becomes dependent on the drug. This is called physiological dependency.
 
The nervous system adapts itself to the drug like a plant growing on a trellis. If you tear the trellis away, the plant will be damaged. You need to remove the trellis gradually and allow the plant to retrain itself to its natural growth pattern.
 
Thus, the nervous system does best in a stable environment. Help your nervous system adapt to life without drugs by maintaining as much stability as you can. This is the way you can take care of yourself and help your nervous system to recover. We are our own worst enemies when it comes to stressing our nervous systems! Examples:
 
3.a. Do not suddenly quit taking your drugs. Do not skip doses to taper. These big, fast changes are the opposite of providing stability for your nervous system. Skipping doses causes the amount of the drug in your bloodstream to go up and down. Do not do this for any psychiatric drug.  See this graph which compares skipping days vs daily dosing.

 

3.b. Avoid binges. Even if you had no problems with them before, avoid overindulgence in alcohol, food, partying, sugar, staying up late, even exercise. All of these put the body and the nervous system under stress.
 
3.c. Manage emotional stress. Yes, that abusive relationship can be keeping you from recovering from withdrawal syndrome. You may wish to reduce contact with any people who tend to upset you. If you are an argumentative person, you may wish to minimize your confrontations.
 
3.d. Direct your time and efforts to pastimes that are calming or pleasurable. Calm is good for the nervous system. Always make time for a pleasant walk of at least a half-hour every day. Many people find a place for meditation in their lives because it makes them feel better. Spending time with pets or in nature ("forest bathing") can also be soothing. See our Symptoms and Self-Care forum for more suggestions.
 
3.e. Keep your daily circadian rhythm steady. Your body runs on a daily pattern governed by sunrise and sunset -- the circadian rhythm. Our bodies do best when we wake in the morning, go to sleep at night, and eat at about the same times every day. You may wish to reduce artificial light at night. Do what you can to maintain a regular daily schedule, this helps your nervous system function. See Important topics about symptoms, including sleep problems.

Edited by ChessieCat
updated 28.12.14 Alto/CC added link to skipping days graph & steady state graph

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wantmyhubbyback   
wantmyhubbyback

might be worthwhile to point out that published medical info on tapering schedules is incredibly wrong

 

https://www.documentforsafety.org/pub/forms/tapering_of_antipsychotic.pdf--25% a WEEK! yikes

http://www.medscape.com/viewarticle/529317#vp_2-- "4-8 weeks" -- yikes again!

http://www.nmsis.org/pages/preventdiscontinuationsyndromes2.asp-- "4 weeks to 3 months" -- still wrong.

 

who are the people writing this crap?

it continues to floor me that the psych community still doesn't understand or seem to care about getting people off of these drugs. i get the whole revenue stream, big pharma, "fox in henhouse' thing ...but still, wow.

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Altostrata   
Altostrata

At least they give some idea of what "tapering" means.

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Carouselisalie   
Carouselisalie

Great recommendations.

 

Capacity for self regulation is often lacking in those of us with nervous systems altered to adapt and survive traumatizing social environments. Limited self regulation is often what leads people to starting on anti-depressants and mood stabilizers in the first place.

 

Self regulation and groundedness are skills and capacities we can learn and develop. Good book: "Full Body Presence" by Suzanne Scurlock-Durama.

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Altostrata   
Altostrata

Good points, Carousel. Thank you.

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2befree4me   
2befree4me

Thank you so much for all your work on this site and advise.  This is an invaluable site and am so glad I found it.

 

 I personally love my two cats and one dog a jack russell, I will sometimes on my lunch break come home, lie down and let them all surround me with there love to help me get through the rest of the day.

 

just thought I would throw that in.

 

keep on keeping on

Xena

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dukke   
dukke

Thank you Altostrata!  Thank you very much for your contributions! This information is very valuable, especially since doctors who should know better are completely ignorant.

 

May I add a bit of my experience? It might help others, hopefully..

 

In my situation I believe doing physical exercise is extremely helpful, especially cardio based exercises. I was able to tapper several drugs at once and at a rate of more than 10%, some drugs 25%, others 50%... without any significant withdrawal effects. Am now only taking 35g of seroquel, which seems to be extremely hard to tapper below these dosage, this is a dosage that I believe is not prescribed to anyone since it's so low. 

I still don't feel good, I suffer quite badly from depression, but am feeling better now.

I believe it would be beneficial to add this to the list, and remove the advice of not doing too much exercise which in my experience doesn't apply, quite the contrary (just have the normal precautions anyway has even people that don't take psychiatric drugs).. I believe a solid diet and physical exercise are very important. 

 

I know at least one more person who has "traded", on his own, psychiatric drugs for exercise, with success. He's into iron man (or something along those lines) which is an extremely intense exercise competition. 

 

Please don't get me wrong, I just wish to add to your information, you did a great job.

 

Thanks,

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Altostrata   
Altostrata

Thanks, dukke.

 

Some people do better with strenuous exercise and some do worse. It's something to try if you're in condition for it, but it can backfire.

 

Please let us know how you're doing in your Intro topic dukke: Tapering seroquel

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jenthorz   
jenthorz

Thank you for this. I found out about number 2 the hard way. 

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curineia   
curineia

 

 

Thank you for reminding me of this. ❤❤❤

Edited by mammaP

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