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About reinstating and stabilizing to reduce withdrawal symptoms

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Altostrata   
Altostrata

ADMIN NOTE This topic is a general discussion of the principle of reinstatement. For case-by-case consideration of what YOU should do, please put your questions in an Introductions topic.
 
Do not put those questions in this topic, because detailed discussion of YOUR particular circumstances will take it off track and make this topic difficult for others to follow. The moderators will move any questions about YOUR particular case to the Introductions forum. Thank you.
 
Also see

After Reinstating or Updosing, How Long To Stabilize?

Stabilizing after a reduction -- what does that mean?


 

 

Don't suddenly go off medication assuming that reinstatement is a safety net. This is one of the reasons we advocate gradual tapering to minimize withdrawal symptoms. Once the nervous system is destabilized by withdrawal, all bets are off.

Medicine wants to believe the acute phase of withdrawal lasts only a few weeks. From what people have posted on the Web, it can last many months.

The inserts in all the newer antidepressants and many other psychiatric drugs advise reinstatement of the medication if withdrawal symptoms appear. This is all medicine knows about how to treat withdrawal.

What is known about reinstatement
from my reading and from patient experience as posted on online support sites:

  • According to medical knowledge, reinstatement is the only way to alleviate withdrawal symptoms.
  • Reinstatement is best done immediately upon appearance of withdrawal symptoms. The more time that passes, the less likely it is to work.
  • The length of this window of opportunity varies according to the individual. Sometimes people can reinstate successfully months after quitting. Others cannot.
  • Often a partial dose will relieve withdrawal symptoms. If, for example, you were taking 20mg Paxil and quit rapidly only a few days ago, 5mg or 10mg may be enough. Others find they need a higher dose.
  • Start low to see what you need. You can always increase if necessary. If you've been off the drug for a month or more, many people can find relief from antidepressant withdrawal symptoms by reinstating as little as 1mg-5mg.

Additional reasons to reinstate only a partial dose
Reinstating at a low dose reduces the risk of severe adverse reactions in case reinstatement does not work.

  • Experiencing withdrawal may have sensitized you to drugs and a larger dose will cause an adverse reaction.
  • These drugs are vastly more powerful than they need to be; often reinstatement at half dosage AT MOST is sufficient and many people do well with a lot less. You want to be taking only the lowest EFFECTIVE dose.
  • Your receptors may have adjusted somewhat (upregulated) during the time you were tapering or had withdrawal symptoms.
  • If you can stabilize on a lower dose, you have less to taper when you finally do go off.
  • If you had adverse reactions while you were taking the drug, a low dose may not trigger the adverse reactions but still reduce withdrawal symptoms. Adverse reactions tend to be dosage-related: The higher the dose, the worse the reaction.
  • You can always adjust the dosage upward if you find you need to.

How long should you give reinstatement?

  • It takes at least 4 days for your body to fully register the addition of a neuroactive drug. Unless you have an immediate bad reaction, observe your symptom pattern for about a week to see if the reinstatement is helping. If you have an immediate bad reaction, reduce or stop taking the drug.
  • After reinstatement, the amount of time needed to alleviate withdrawal symptoms (stabilizing) varies according to the individual. Relief can be felt immediately, after some weeks, or after some months.
  • Once you feel withdrawal symptoms are reduced after reinstatement, give your nervous system time to stabilize before attempting dosage reduction. Think in terms of months, not days.
  • Be patient after you reinstate. Reinstatement may not immediately eliminate all withdrawal symptoms. You may still experience waves of symptoms, which usually lessen as time goes on. Do not attempt to taper again until you feel symptom-free, or at least until your withdrawal symptoms are mild and tolerable.
  • The dose needed for effective reinstatement varies according to the individual.

When to discontinue reinstatement
If, upon reinstatement, you very soon feel worse, most likely you are sensitized to the drug and need to take a smaller dosage or, possibly, none at all.

  • Sometimes reinstatement does not work. The nervous system has taken such a hard hit from withdrawal, it's destabilized beyond whatever effect the drug might have had.
  • Sometimes reinstatement not only does not work, it causes an adverse reaction from a nervous system sensitized by withdrawal.
  • If you have an immediate bad reaction, reduce or stop taking the drug.

Reinstate at what dosage?
Sometimes reinstatement not only doesn't work but makes symptoms worse. That is why we often suggest very, very low doses -- to reduce this risk. Higher doses can go wrong in much bigger ways. A very low dose is a way to explore the option with less risk.
 
The dosage is always going to be a guess. Here are some factors that might influence the dosage of reinstatement:

  • How the person quit the drug and how long he or she's been off it. If you've just cold-turkeyed 20mg Celexa a few days ago, you might reinstate at closer to your original dosage, such as 10mg. (It may not be necessary to go back to 20mg, standard dosages tend to be overly powerful.)
  • If you've had withdrawal symptoms for a month or more, it's likely your system is somewhat sensitized to drugs. For example, if you had been taking 20mg Celexa, you might wish to try reinstating at a lower dosage, such as 2mg-5mg. It may seem incredible, but these tiny doses are often sufficient to reduce withdrawal symptoms.
  • Your present condition. If you have symptoms of hyper-reactivity, alerting (anxiety, panic, sleeplessness), you may be too sensitive for reinstatement. If you want to try it anyway, you might wish to try reinstating at a very low dosage, such as 1mg if you had been taking 20mg Celexa, for example, or other SSRIs with a standard dosage of 20mg.
  • How long you've been off the drug. If you've been off the drug for many months, reinstatement is less likely to work. If you want to try it anyway, you might wish to try reinstating at a very low dosage, such as 1mg if you had been taking 20mg Celexa, for example, or other SSRIs with a standard dosage of 20mg.
  • Other drugs you're taking. Be very careful adding a drug to other drugs. Use the Drug Interactions Checker before even considering this. (Your symptoms may be due to drug-drug interactions.)

None of the above are hard-and-fast rules. There are reports of people with prolonged post-withdrawal syndrome who did better taking a drug at full dosage 2 years later. If you want to do this, please consult a doctor, we cannot advise you on it.
 
About benzo reinstatement http://www.benzosupport.org/notes_on_reinstatement.htm

 


 

ADMIN NOTE:  Useful Excerpts from the thread

 

NZ11 in post 74http://survivingantidepressants.org/index.php?/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/?p=120338

 

Alto in post 75, additional explanationhttp://survivingantidepressants.org/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/?do=findComment&comment=120438

 

Alto on Hypersensitivity:  Reinstatement is more likely to work if done fairly soon after stopping a drug, while the nervous system is still somewhat shaped around the drug that's been removed. The window of opportunity is not definitely a month, and probably varies from individual to individual, but reinstatement is best done sooner rather than later. 

 

This makes waiting to see if withdrawal symptoms will go away a difficult choice. If you wait, they may go away or you may miss your chance for effective reinstatement. (Medicine assumes withdrawal symptoms last only a few weeks; it's a sign you're in for a longer period of recovery if your symptoms have not diminished over this amount of time.) 

 

A while after discontinuation, the nervous system changes and may no longer accept reinstatement of the drug to repair the withdrawal reaction. It's like a series of dominoes gradually falling over time. Hypersensitivity can set in making reinstatement very difficult, as the nervous system will react in strange ways to the original drug and often other drugs as well. 

 

(A combination of Celexa with trazodone and nortriptyline can result in serotonin syndrome in anyone. If one's nervous system has been sensitized by withdrawal syndrome, this can cause disastrous adverse effects.) 

 

This is why when someone has been off the drug for more than a month, we suggest trying a very low dose. Hypersensitization is so common with withdrawal syndrome, trying a very low dose initially reduces the risk of a severe adverse reaction. And quite frequently, a very low dose will work to reduce withdrawal symptoms.

 

Edited by ChessieCat
updated AS 5 Sep 17/CC added link to post 75

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cmusic   
cmusic

So I just read the post on stabilizing...

 

"Most people are stable on psychotropic medications before their first taper, so there are no withdrawal symptoms. Holding helps to stabilize withdrawal symptoms that are acquired while tapering, going off CT, etc."

 

My issue is that I haven't been stable like this for three years. The meds have stopped working and I believe I have been in some kind of withdrawal while still on meds. This the whole notion of tapering didnt make any real sense to me.

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Altostrata   
Altostrata

Sorry for the confusion, cmusic's question was answered in his topic http://survivingantidepressants.org/index.php?/topic/3677-cmusic-a-long-history-and-finally-saying-enough/page__p__42103#entry42103

 

If your symptoms have gotten worse, that's a sign the Prozac was doing something. A higher dose might have made you worse, but a very low dose might help the withdrawal symptoms.

 

Low-dose reinstatement may reduce the withdrawal symptoms experienced after quitting. These would be new symptoms different from the adverse effects of the drug while you were taking a full dose.

 

"Stabilizing" as we use it means reducing withdrawal symptoms. It doesn't mean resolving whatever problems you might have had before going on the drug, or returning you to a perfect state of mind or body. Sometimes reinstatement works only slightly -- at least that's better dealing with the full force of withdrawal symptoms.

 

And, unfortunately, sometimes it does not help at all.

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Meimeiquest   
Meimeiquest

My little experience: Jumped off Zyprexa 12/29/12 after a few months taper (don't remember the start...no idea it would matter). Mostly was on Zyprexa 5mg, jumped off at about 0.6 mg. tried a dose of 0.2mg 4/713. Slept too much, missed a work deadline, totally sedated, screaming at my husband (I know those 2 shouldn't go together). And the nausea that I was trying to stop re-emerged at 11 a.m. But otherwise it went well :).

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Altostrata   
Altostrata

Some people get over withdrawal symptoms such as the brain zaps, and some people get worse for a long time. We don't believe in trying to tough it out when you get severe symptoms.

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Ellen042   
Ellen042

Sorry if I missed a thread that explains this, but why does reinstatement only work within one month of stopping or reducing the dose of a drug? What happens if it is reinstated later?  I'm curious if this explains why I developed serotonin syndrome when I took Celexa- to the point of having to stop it immediately. I had taken Celexa earlier in my life with no problems, but I wasn't on the trazodone and nortriptyline at the same time.  Either way, does reinstatement after a month just cause the drug to be ineffective, or does it make you have an adverse reaction?  Don't bother answering if you haven't the time, as I'm not facing this situation right now, and others need help.  Just thought many would have the same question, and perhaps there's a link to a article to make answering easy.  Thank you!

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Meimeiquest   
Meimeiquest

I think it becomes a wild card after that. After two months even more unpredictable. Reinstating a tiny portion and titrating up if needed is more likely to be successful. But it does help some. In my "virgin" round of AD, I stopped several times for six weeks, had a stomach ache I thought was depression, and reinstated each time with immediate relief. But that was Prozac, with it's long half-life.

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Altostrata   
Altostrata

Here's the topic about reinstatement, Ellen.

 

We need to think of the nervous system as dynamic. As time goes on, it adapts as well as it can to the lack of the drug on which it became dependent, and may become intolerant of that kind of interference.

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arwen   
arwen
It looks like reinstalling can work even after 3-4 months after stopping. I will see, now it is very early to be sure.

 

I stopped Paxil at the end of last November, after a slow and long tapering. I started 2 and a half years ago at 10 mg, then 20 and then going down. It worked very well until the very end, I decreased 10-25% each time, then stabilizing for weeks (it worked for me). I had symptoms, anxiety, brain zaps, tremors, but manageable. 

 

The last drop, from 1 mg to nothing was not good. At the beginning it was fine, but after 2 months I crashed, the symptoms became unbearable. The knot in the stomach was never leaving me. I was fearing an unknown catastrophe will happen any minute. 

 

I had to reinstall at 1 mg and after one week I feel much better. 1 mg is a tiny quantity, I cut the 10mg pill in 8, and then remove some, but it can make such a difference! 

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UnfoldingSky   
UnfoldingSky

Sorry if I missed a thread that explains this, but why does reinstatement only work within one month of stopping or reducing the dose of a drug? What happens if it is reinstated later?  I'm curious if this explains why I developed serotonin syndrome when I took Celexa- to the point of having to stop it immediately. I had taken Celexa earlier in my life with no problems, but I wasn't on the trazodone and nortriptyline at the same time.  Either way, does reinstatement after a month just cause the drug to be ineffective, or does it make you have an adverse reaction?  Don't bother answering if you haven't the time, as I'm not facing this situation right now, and others need help.  Just thought many would have the same question, and perhaps there's a link to a article to make answering easy.  Thank you!

 

I had the same issue more or less.

 

I was on an SSRI, though it didn't seem to do much one way or another.  I stopped it abruptly and somehow was okay doing that.  Then months later I re-started the same drug and all of a sudden had severe problems with it. 

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Altostrata   
Altostrata

Reinstatement is more likely to work done fairly soon after stopping a drug, while the nervous system is still somewhat shaped around the drug that's been removed. The window of opportunity is not definitely a month, and probably varies from individual to individual, but but reinstatement is best done sooner rather than later.

 

This makes waiting to see if withdrawal symptoms will go away a difficult choice. If you wait, they may go away or you may miss your chance for effective reinstatement. (Medicine assumes withdrawal symptoms last only a few weeks; it's sign you're in for a longer period of recovery if your symptoms have not diminished over this amount of time.)

 

After a while after discontinuation, the nervous system changes and may no longer accept reinstatement of the drug to repair the withdrawal reaction. It's like a series of dominoes gradually falling over time. Hypersensitivity can set in making reinstatement very difficult, as the nervous system will react in strange ways to the original drug and often other drugs as well.

 

(A combination of Celexa with trazodone and nortriptyline can result in serotonin syndrome in anyone. If one's nervous system has been sensitized by withdrawal syndrome, this can cause disastrous adverse effects.)

 

This is why when someone has been off the drug for more than a month, we suggest trying a very low dose. Hypersensitization is so common with withdrawal syndrome, trying a very low dose initially reduces the risk of a severe adverse reaction. And quite frequently, a very low dose will work to reduce withdrawal symptoms.

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alexjuice   
alexjuice

Reinstating probably two or more animals. In cases where a person is taking 2 or more drugs, stops only ONE rapidly and destabilizes, reinstating would work better. In cases where a person rapidly removes all drugs, reinstating would be more of a crapshoot because taking any drug immobilizes the detox organs to some degree so stopping all drugs will create more problems due to toxin mobilization and this adds an extra layer of complexity which makes the reinstatement more unpredicatable.

 

In one case this is a good theorectical argument in support of coming off drugs one at a time rather than detoxing a group of meds more gradually and all at the same.

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Altostrata   
Altostrata

alex, I'm not sure what you mean by "immobilize the detox organs."

 

When someone quits more than one drug at once and develops severe withdrawal symptoms, it's true that reinstatement is a crapshoot, in many ways. Which drug to reinstate, should it be both drugs, and at what dosages can only be guessed.

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alexjuice   
alexjuice

There is evidence from Stuart Shipko that benzos immobilize the gallbladder to a degree. One part of the withdrawal syndrome of benzos is, I presume, due to a remobilization of the gallbladder once the benzos are removed after which reactive particles would be more rapidly released and these would be very damaging in the body, causing inflammation and sensitivity to sound, for instance, insomnia, and for instance and hypothetically many other symptoms. The idea is that this part of the syndrome will only kick in once the drugs are stopped entirely, I assume the antidepressants and antipsychotics all slow the liver, gallbladder or other organs to some degree by, at the least, demanding resources for their own metabolization and this causes roadblocks and results in a buildup of toxins which are released once all the drugs are removed.

 

I think one part of w/d is probably simply removing the roadblocks and allowing the organs of the body to work more effectively -- unfortunately causing an avalche of release in the 'acute' phase of the syndrome. So this part of the problem would strike only after all the drugs are removed. Removing one drug of a multi-drug regimen would not affect the terrain in this way.

 

I take this from my experience with the mold doctors who have told me repeatedly that their patients do not recover until they are able to remove the mold metabolities and this doesn't happen until the drugs are finally gone 100% at which point the mold toxins can and do come down reasonably quickly. My experience with the mycotoxin urinalysis before and after my final d/c supports this and if it is true that rapid toxin release from GB and liver occurs after d.c then I have to think all cases would be affected by toxin release to some degree.

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Altostrata   
Altostrata

I think you and other members who have co-existing conditions such as parasites, mold infection, Lyme disease, etc. have special problems that might be related to organ functioning.

 

But for most people, going off psychiatric drugs is more likely to cause nervous system destabilization rather than organ malfunction. I don't think the liver or gall bladder become dysfunctional and there is no issue with toxins being released -- it's a gradual, natural body function.

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alexjuice   
alexjuice

To some degree the nervou system remains dysfunctional for so long because of the presence of a roadblock. If I imagine a roadblock of a physical kind it makes more sense to me why recovery can take so long. I only really know for me and my case though but I think theoretically the argument is strong for some factor like this as a part of every case. Also the toxins aren't the drugs or anything to do with the drugs, necessarily. The regular toxins of everyday life back up. This should be measurable actually but it's outside the mainstream of medicine and otherwise costly.

 

The main point, in the context of this topic, is that if toxin release plays a role in this syndrome the issue would only be unleashed after all the drugs were removed. So that if a person crashes after removing one benzo and is still on, say, a Zdrug, an SSRI and an SNRI, then it's fair to think their w/d symptoms are unrelated to this mechanism because in theory the eliminative organs are still backed up.

 

This is speculation on my part. Someday I may try to solve this part of this issue myself for other people who are suffering, depending on my own outcome, because I have tons of specialized experience in this area.

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Altostrata   
Altostrata

Correct, my parenthetical comment was on Ellen's post.

 

Alex, nervous system dysfunction is undeniably a problem in withdrawal syndrome and treating withdrawal syndrome. However, I disagree with your theory that going off all psychiatric drugs unleashes toxins. There are dozens and maybe hundreds of liver enzymes. While a drug might preoccupy one or more, the others are still working. The liver has multiple avenues of detoxification, as do the other organs.

 

I  can't extrapolate from what Dr. Shipko said, perhaps you can contact him and ask him to elaborate in regards to a case such as yours, in which going off drugs seemed to make you susceptible to opportunistic infection.

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arwen   
arwen

In my experience, each time I decrease the dose, I have some symptoms. The decision to updose or reinstate depends entirely on the severity of the symptoms. Brain zaps, tinnitus, lighthead, uncomfortable in my own skin, waking up trembling, all this I can bear. But when the dizziness doesn't allow me to go to work, the fear is so extreme, I don't want to exit the house, I am continuously tense or crying, then I know I did it too fast, and I have to go back to the last dose.

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nz11   
nz11

"Once the nervous system is destabilized by withdrawal, all bets are off."

 

Wow this is the exact conclusion i had come to and had said a very similar thing on another site....my words were "once the wdl nightmare is triggered its very difficult to reign it back in and all bets are off the table" I have likened it also to trying to back the car up the freeway off ramp ...not an easy thing to do.

 

This thread is incredibly informative. 

 

Thankyou so much for this truly insightful info.

This conundrum has really been on my mind over the last year and had me at a loss as to how to attack it.

 

It has really been a dilemma for me as to what to suggest to help a person who has tapered too fast ...as one does  ...doctors are just clueless idiots....and then observe them watching the fish flap around on the beach for a week oblivious to the incoming wdl tsunami.

The difficulty is most cannot hang around very long on a small dose when all hell breaks loose...the suffering is too much.

I previously couldnt understand why rec going on at a low dose is useful when surely getting back in the bunker would be best when getting carpet bombed. Not many people can absorb this for very long. It also brings many voices to the table as to what is the best game plan. It really is a most dreadful place to be in.

 

I often thought the best bet could be to go back on at the dose one would have been on had they been doing the 10% taper ...if you know what i mean .

 

This has given me a lot to think about ...wow !! I am always prepared to change my thinking when presented with good evidence to do so. Thanks.

Best thread i have read so far!

Beginning to like this site more and more.

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nz11   
nz11

Oh ...how stupid of me ...I thought it might have something to do with shooting a piece of cow dung and sh*t goes everywhere....well what ya know...this country boy from nz learns something new everyday!

 

So what I think you are implying is 'crap shoot' .... means  the odds of a win are heavily loaded against you, ie the house always wins !

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Ever   
Ever

Don't think it's quite like that Mark.  It's not so much heavily weighted against you, it's more that you just don't know.   Anything can happen - you roll the dice and take your chances. 

 

I've re-instated dozens of times over the past decade or so - gone from zero back to 20mg many times.   Been off for more than a year and gone back on.  No problems at all.   I wouldn't do it again (not back to 20mg anyway) - I now realise how lucky I've been so far, but I've just successfully re-instated yet again after more than two months off and feeling great now.   

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Altostrata   
Altostrata

We see lots of people here do better with reinstating, but some do not. It's unpredictable.

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WiggleIt   
WiggleIt

Hey Alto and CW,

 

I'm trying to get some info straight about stuff that I have read on this site. In one of the reinstatement threads, actually I think it might be a thread about what to expect from your doctor, it says that you need immediate medical attention if you're experiencing severe withdrawal symptoms. It also says reinstatement of a partial dose and slow tapering is the standard in psychiatric care.

 

But I've seen in other places on here where it says reinstatement is no guarantee and could actually make things worse, especially if some time has gone by and especially when there are movement symptoms involved.

 

How can a new person sort through that information and decide what to do?

 

How long is considered generally too long to reinstate?

 

What are the risks of severe withdrawal on a slow taper?

 

If the person had side effects while on the med, is reinstatement advised anyway?

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nz11   
nz11

1. How can a new person sort through that information [ri] and decide what to do?

 

2. How long is considered generally too long to reinstate?

 

3. What are the risks of severe withdrawal on a slow taper?

 

4. If the person had side effects while on the med, is reinstatement advised anyway?

Everyone else must be asleep so i'll be cheeky and put some cards on the table and we'll see how they fall.

 

1. A new person can put up their drug signature and details, taper history and people can then point them in what has shown to be the best observed direction. A new person needs to spend time reading this stuff to get up to speed on the true informed place they now find themselves in. And if they value their health and desire to take responsibility for it, instead of blindly trusting the doc then they owe it to themselves to spend this time. A too fast taper triggering the wdl nightMARE to bolt puts a person in a place where 'all bets are off ' as to how to resolve it. Ri at a low dose is the first preferred option of this site, other options are listed in the thread about this. This is not an exact science so no one knows whats going to happen until you try an option.

 

2. How long is a piece of string? Its been shown a ri as soon as possible is best ...i think 2 months is  starting to get a tricky time. Having said that i know of people who have ri after 11 months off and stabilize ok and then gone on to taper off successfully (mapleleafgirl). So really there is no set rules imo. But sooner is better.

 

3. The risks of severe  wdl symptoms on a slow taper (10% ) are hopefully minimised. This is a rate that has been proven to be successful/provide the best chance  in getting people off the drug.  However lets be clear on something ..despite a slow taper even 5% there is no guarantee of zero wdl symptoms. But hopefully it should make them short in duration and manageable allowing one to have a life while tapering. You are going to have to absorb some  wdl no matter what rate you taper imo. One can listen to their body and know whats happening and slow the taper even more. Starting slow is key. Then if the coast is clear you can proceed.

 

4.  What side effects are you referring to? If you have done a fast taper ...as basically we all have because our doctors are clueless ...and you cant cope drug free and are starting to use the 's' word then i think you have no option regardless, but to ri and try to stabilize. imo. If you are referring to pregnancy then that is a curly one and i don't know what call to make, as a clueless mere male, except to say maybe  the health of the mother would be paramount. But others wiser than me could better advise.

 

Well its time for me to join the rest of the world and go to sleep. That's my 2 cents worth in the meantime you'll just have to wait until the mods arise and shine. Mind you there should be some Aussies awake at this time...they are 2 hours behind us....actually come to think of it Aussie 's are behind Kiwis in a lot of ways really... ..

Goodnight.

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WatchingTV426   
WatchingTV426

I think I know the answer to this from all the reading I've done here, but I'll ask anyway. If you reinstate but show no improvement in say, 3 weeks (or 4 or whatever), you then still have to taper off that low dose to avoid making withdrawal even *worse*, right? 

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Altostrata   
Altostrata

nz has got it! 41.gif

 

I have tried to explain reinstatement as clearly as possible in #1. It's pretty simple, really: It's trial and error, which is how these drugs have been prescribed all along.

 

The window in which reinstatement is effective is not defined. The assumption behind "immediate medical attention" when withdrawal symptoms surface is that withdrawal symptoms occur quickly after discontinuation. In other words, reinstatement should be done within a couple of weeks of quitting. However, we know that withdrawal symptoms can be delayed, so we recommend reinstatement as soon as possible.

 

I think the confusion is because we *expect* that taking a drug is going to work, we *expect* words like "always" and "guaranteed". it's hard to accept it that there is no certainty when it comes to psychiatric drugs and never was.

 

Also, doctors and the general public have the idea that "more is better", but now we're in a territory where more might be worse and we have to avoid it with a cautious exploratory partial dose when attempting reinstatement.

 

Now, given another principle -- to keep your nervous system as stable as possible and avoid big drug changes -- even if your reinstatement has lasted a short time, you would want to go off gradually. Maybe not as gradually as 10% per month, but a fast taper. You might want to try a 10% reduction to start, in case your nervous system has already become dependent on the drug even though you don't feel any effects.

 

If you have adverse effects from the reinstatement, which you should track by taking notes of your daily symptom pattern Keep Notes on Paper, in case they're from something else, you will want to go off faster. This is a case-by-case consideration to be done in your Introductions topic, not in this topic, because such detailed discussion will take it off track and make this topic difficult for others to follow.

 

If you had adverse effects from the drug when you were on it and are suffering withdrawal symptoms, reinstatement could be tried at a low, partial dose. Side effects are dosage-related: Lower doses incur fewer side effects. The adverse effects you felt on the drug indicate it was probably always too high a dose for you (or wrong for you entirely).

 

It is possible that at a low dose, you can reduce withdrawal symptoms and not suffer the adverse effects you suffered before. Again, this depends on the adverse effects and your current symptom pattern, another case-by-case consideration to be done in your Introductions topic.

 

What do we mean by a partial, low dose? You may notice we often suggest trying reinstatement of antidepressants at doses as low as 1mg-5mg, particularly if someone has been off the drug for more than several weeks. Believe it or not, people have found relief at those low doses and then tapered off successfully later.

 

However, since drugs are dosed at different levels, a partial, low dose of another drug, such as Abilify, might be 0.25mg, or of Neurontin, 10mg. Since people are on different drugs, the dosing is another case-by-case consideration to be done in your Introductions topic.

 

Edited by ChessieCat
Added Keep Notes on Paper Link and made Abilify 0.25 easier to see dose

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Altostrata   
Altostrata

Alto, I know you have written it's on a case by case basis so maybe I'm just being a bother, but, I could swear I read off-site that in cases where people have TD issues come out while on the drug RI doesn't work, at least to cover over the TD.  Are there people here who had TD-like symptoms on the drug who reinstated successfully?

 

If I did read that it would have been about antipsychotics, since the bulk of what is written about TD focuses on them.

 

If someone developed tardive dyskinesia while on a drug, I would be wary of reinstating it.

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Vonnegutjunky   
Vonnegutjunky

So I am almost a week stabilized after 3 months of a double dose of reinstatment A

 

it was like a switch just flipped on Tuesday and bam I feel normal! I still have ringing in my ears, some side effects, a little anxiety but all of these things are before and after medication symptoms so I would not say they are wd related.

 

My doc really wanted me to switch meds- she said the Paxil was no longer working- I can't say I will be like this in an upward feeling of normalcy without anymore waves; I don't discount that I will probably have some, but it really is a huge difference; I think patience is the key with reinstatment (imo) as alto says our cns is unstablized and it needs stability.

 

So just wanted to post my experience here; and I hope my bad wd experience has prepared me for anything I might face when I begin to taper next year.

Edited by scallywag
inserted paragraph breaks

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Colonial   
Colonial

Alto posted earlier in this thread:
 
 

 

Reinstatement is more likely to work done fairly soon after stopping a drug, while the nervous system is still somewhat shaped around the drug that's been removed. The window of opportunity is not definitely a month, and probably varies from individual to individual, but but reinstatement is best done sooner rather than later.This makes waiting to see if withdrawal symptoms will go away a difficult choice. If you wait, they may go away or you may miss your chance for effective reinstatement. After a while after discontinuation, the nervous system changes and may no longer accept reinstatement of the drug to repair the withdrawal reaction. It's like a series of dominoes gradually falling over time. Hypersensitivity can set in making reinstatement very difficult, as the nervous system will react in strange ways to the original drug and often other drugs as well. This is why when someone has been off the drug for more than a month, we suggest trying a very low dose. Hypersensitization is so common with withdrawal syndrome, trying a very low dose initially reduces the risk of a severe adverse reaction. And quite frequently, a very low dose will work to reduce withdrawal symptoms."

 
 
Colonial:  I have Never dropped below 10mgs of Paxil.  Which is well below therapeutic levels but, as I remember from the SERT curve study, is still enough to re-wire around 75% of your brain receptors.
 
So while I have been at this level almost 4 months do you think that since I never dropped below the 10mgs I may have better luck with "reinstatement" if the doctor wants me back up at higher doses?  I realize these studies are usually done on "virgin" brains, and after dropping down to 10mgs from being at 25 for almost 22 years, what my brain "looks" like may be different, but could there may be some "positive" news to having never dropped below that 10mg level for reinstatement purposes?

Edited by scallywag
moved quote to a quote box for clarity

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Altostrata   
Altostrata

If you've suffered withdrawal symptoms at any dosage, your nervous system may be sensitized to all psychiatric drugs.

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Bking25   
Bking25

hello I haven't posted on this site before but i used it regularly in my withdraw.  I was on medication since i was 18 years old and stopped when i was 31.  My last medication was lexapro, I slowly tapered myself down for an entire year.  The last day was hell i suffered from unrelenting dp/dr suicidal thoughts inability to put sentences together i suffered med free for 16 months, I couldn't read or listen to music i couldn't even go outside without suffering major dp.  I was afraid to drive and had thoughts that would enter my mind out of nowhere to go drive off a bridge.  I would see evil faces on people out of the corner of my eye that really scared me.  needless to say i was a mess.  I worried my family and nearly drove my very loving girlfriend into a break up.  I went to every doctor and had every test known to man.

I finally landed my dream job and was scared to death to take it.  my anxiety dp d/r was so great i decided to go to the doctor. and was prescribed 25mg zoloft i read so many post saying it would never work and it would just make things worse. i was very anti medication and i believed i was a lost cause i believed what i read on here and made it true in my mind that i was hopeless.  thankfully Thats not my experience. I have been on zoloft now for two months the first two weeks were classic when starting an ssri increased anxiety etc.  I am currently a different person I am a firefighter like i always dreamed of and worked so hard pre withdrawal. my dp is 99% gone and my depression is about 70 % better. I can concentrate as well as listen to music. I'm not 100% but reinstatement WORKED for me it changed my life.  I am ok with being on medication again I have my life back. my girlfriend is very happy and it still brings tears to my parents eyes when i call and say "im doing good mom"  because for so long that was not the case  My mother and father have their son back and my brothers have their big brother back! i know this is an anti medication web site i just felt compelled to reach out to those on the brink of suicide I was there i had no quality of life and yes if taking medication pulls me back from the ledge and gives me a quality of life that i didn't have before then so be it .good luck to all and find your own path. Don't give up      THERE IS HOPE!

Edited by KarenB
added bold to main part of message

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Altostrata   
Altostrata

Reinstating is the only way medicine knows to reduce withdrawal syndrome, you've gotten decent advice there. Quite often, we see it works.

 

Needing to reinstate does not mean you have a "mental illness" -- that doctor was wrong. It means you tapered too fast and you need to taper slower.

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starcontrol2   
starcontrol2

Hopefully my experience will help someone.

I tapered from 5mg of Lexapro too fast. Like most was just following what dr was saying. I cut to 2.5 then to 1.25. I never made it to zero. I made it to 0.625mg. I was in severe withdrawal.

Reinstated to 5mg while never reaching 0, also on doctors advice. It made everything worse and totally destroyed my sleep. I waited for 2 months at 5 but couldn't stabilize.

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reachingforthestars   
reachingforthestars

startcontrol, i have similar experience.... a couple of days ago i updosed from 4mg to 5mg and it triggered new symptoms to me. :( Before my symptoms were so much easier compared to this all i had was tiredness and muscle weakness so that i was housebound, and nausea( on and off),  but now i have also terrible insomnia, constant restlessness,  and my eyes are sore. If i could i would undo that updosing...

 

i would really like to hear how long has it took for those of you who has updosed with bad reaction to stabilize? please i need some hope... 

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Vonnegutjunky   
Vonnegutjunky

I also updosed during a too fast taper and everything got really really bad! I waited for 5 months to stabilize before I started reducing again; only now after 2 months of reducing do I have Windows where I feel normal! They come ever 9-12 days but during those windows I feel so much better, more hopeful

 

My advice, if your symptoms got worse after an updose, don't wait 5 months; start shaving your pill; I was in pure and utter despair;

 

My updose made things so much worse

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