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Dr. Peter Breggin's 10% taper method

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Many people come to the realization that their symptoms and difficulty in withdrawal are not worsening mental illness but due to the drugs themselves when they read this book: Your Drug May Be Your Problem: How And Why To Stop Taking Psychiatric Medications by Peter R. Breggin and David Cohen. Chapter 8, How to Stop Taking Psychiatric Drugs, contains a detailed explanation of why and how to use the 10% reduction method.

 

It is posted here to educate viewers about safe tapering. It answers many questions about why to taper slowly, how to taper slowly, and when to slow down even more. Full text, with notes and bibliography, here.

 

Your Drug May Be Your Problem

Chapter 8: How to Stop Taking Psychiatric Drugs

 

You may feel in a rush to stop taking psychiatric drugs. Perhaps you are experiencing distressing side effects or feel "fed up" with being sluggish and emotionally numb. Beware! It's not a good idea to abruptly stop taking drugs without first making sure that there's no danger involved in doing so. In our opinion, it is almost always better to err in the direction of going too slowly rather than too quickly. In rare cases, the development of a severe adverse reaction may require an immediate withdrawal; but if you are having a serious drug reaction, you should seek help from an experienced clinician.

 

Once you have begun to withdraw from psychiatric drugs, don't let anyone—not even your doctor—rush you. Especially if there's a chance that you are going too fast, pay careful attention to how you feel physically, emotionally, and spiritually. At the same time, however, you should take into account the warnings of professionals, family members, or friends who believe that withdrawal is causing you more problems than you realize. You may not be the best judge of your emotional condition as you come off drugs, so you should take into consideration the concerns of people you trust.

 

Gradual Withdrawal Is Its Own Protection

When people take psychiatric drugs, their decision-making faculties may function less effectively. Their feelings are numbed. At these times, if their thinking were expressed in words, it would likely communicate indecision, apathy, or confusion. Or they may experience different feelings in rapid succession, almost as if they were out of control. Because people generally want to think more clearly, to "feel fully" again, and to be more in control of themselves, they are motivated to stop taking psychiatric drugs.

 

Coming off drugs gradually helps to "contain" the emotional and intellectual roller-coaster that sometimes accompanies withdrawal. Indeed, a slow, gradual tapering serves as a discipline upon the withdrawal process. This discipline is backed by available knowledge and sound clinical experience. In the absence of a trusted friend or ally to provide feedback on your progress, in the absence of a support network, gradual withdrawal is likely to be the wisest strategy—especially if you are unsure as to how quickly you should proceed. Even if a medical doctor or other health professional is assisting you or monitoring your withdrawal, a gradual taper is usually the safest strategy.

 

Why Gradual Withdrawal Is Better Than Sudden Withdrawal

The minute a psychiatric drug enters your bloodstream, your brain activates mechanisms to compensate for the drug's impact.1 These compensatory mechanisms become entrenched after operating continuously in response to the drug. If the drug is rapidly removed, they do not suddenly disappear. On the contrary, they have free rein for some time. Typically, these compensatory mechanisms cause physical, cognitive, and emotional disturbances—which are collectively referred to as the withdrawal syndrome.

 

The simplest way to reduce the intensity of withdrawal reactions is to taper doses gradually, in small increments. This way, you are giving your brain appropriate "time" and "space" to regain normal functioning. Unless it is clearly established that you are suffering an acute, dangerous drug-induced toxic reaction, you should proceed with a slow, gradual withdrawal. The longer the withdrawal period, the more chances you have to minimize the intensity of the expected withdrawal reactions.

 

Interestingly, there is some evidence that "gradual discontinuation tends to shorten the course of any withdrawal syndrome."2 In other words, the actual duration of all expected symptoms from drug withdrawal is likely to be shorter if you withdraw slowly than if you withdraw abruptly.

 

In one early study of withdrawal from tricyclic antidepressants, 62 percent of those withdrawn in less than two weeks experienced withdrawal reactions, compared to only 17 percent of those withdrawn over a longer period.3 Because unpleasant withdrawal reactions are one of the main reasons you might be tempted to abort your withdrawal, a gradual taper increases your chances of succeeding and remaining drug-free.

 

In addition, it appears that people who gradually reduce their drug intake find a renewed vigor and energy that they now can learn to reinvest. In contrast to a sudden, unplanned cessation, a gradual withdrawal allows them to find constructive ways to use this energy, to appreciate the new confidence in their abilities that they will develop, and to consoli¬date the new emotional and behavioral patterns that will be learned in the process.

 

One published account describes the case of a woman who wanted to stop Paxil after taking 20 mg daily for six months. Her doctor abruptly cut this dose in half, to 10 mg daily, and gave her the new dose for one month. Then, during the following two weeks, he gave her 10 mg every other day. On alternate, nondrug days, the woman experienced severe headaches, severe nausea, dizziness and vertigo, dry mouth, and lethargy. The dose was reduced to 5 mg daily but, convinced that this only prolonged her agony, she stopped abruptly. She is reported to have experienced two weeks of various withdrawal symptoms and then to have fully recovered.4

 

A more gradual taper, rather than an abrupt 50 percent reduction at the start, might have reduced the severity of this woman's overall withdrawal reactions. Granted, many users of psychiatric drugs do cease them suddenly, without experiencing any significant withdrawal pains. Our experience, however, suggests to us that abrupt withdrawal is chosen by people who are not properly informed or supervised, who cannot tolerate their drug-induced dysfunctions any longer, or who act impulsively because they perceive that no one is listening to them or understanding their suffering.

 

Remove Drugs One at a Time

Many people, perhaps yourself among them, take several psychiatric drugs simultaneously. Common psychiatric drug combinations include an antidepressant and a tranquilizer; a stimulant and a tranquilizer; lithium and an anticonvulsant; or a neuroleptic, an antiparkinsonian, and a tranquilizer.

 

You can withdraw from several drugs simultaneously, but this is a risky strategy. It should be reserved for cases of acute, serious toxicity. In addition, since drugs taken together (such as neuroleptics and antiparkinsonians) often have some similar effects, withdrawing them together can make withdrawal reactions worse. If you intend to withdraw simultaneously from two or more drugs, you should do so under the active supervision of an experienced physician or pharmacist.

 

When you take two drugs, your brain tries to compensate not only for the effects of each one separately but also for the effects of their interaction. The physical picture gets even more complicated with each additional drug. The increasing complexity goes far beyond our actual understanding, creating unknown and unpredictable risks during both drug use and withdrawal. In cases of multidrug use, withdrawal is like trying to unravel a thick knot composed of many different strings—without cutting or damaging any of the strings. In this analogous situation, you would have to proceed quite carefully indeed, gradually disentangling one string and continually adjusting the others in response to the ongoing progress.

 

It is usually best to reduce one drug while continuing to take the others. The process begins anew once you've eliminated the first drug completely and have gotten used to doing without it.

 

Which Drug Should Be Stopped First?

If you want to get off more than one drug, there are some considerations in deciding which drug to stop first. Let's say you're taking drug "A" to counteract the side effects of drug "B"; in this case, you should probably start withdrawal with drug "B." For example, if you're taking a sleeping pill for insomnia caused by Prozac or Ritalin, you may want to delay withdrawal from the sleeping pill until you have begun to reduce the Prozac or Ritalin. Similarly, if you're taking Cogentin or Artane or some other drug to suppress movement disorders caused by neuroleptics, you should probably first reduce your neuroleptic before you attempt to withdraw from the Cogentin or Artane.

 

Because benzodiazepine tranquilizers often provoke unpleasant, lengthy, and potentially dangerous withdrawal reactions, some people choose to withdraw from their use last, after they've experienced withdrawal from other drugs and strengthened their resolve and gained confidence.

 

The 10 Percent Method

Pharmacy textbooks often describe the 10 percent withdrawal method, especially with regard to benzodiazepine tranquilizers. It may be applied to any psychiatric drug. If you wish to stop taking psychiatric drugs, the 10 percent method (or variations on it) can be a good starting point.

 

This method generally stipulates that withdrawal be carried out in approximately ten steps, or 10 percent at a time. Sometimes, the very last step is itself divided into a series of smaller steps. The duration of each step may vary from a few days to several weeks or months. Thus, if an individual stops a decade-long use of tranquilizers or neuroleptics, each step could sensibly last two or three months, barring any major difficulties. Many older persons have been taking tranquilizers daily for over twenty years. In these cases, a withdrawal period of two years is not unusual.

 

The 10 percent method is not absolute. It should be adapted to individual situations and changing circumstances. As we mentioned, withdrawal needs to be sensitive to each individual's developing situation as the process unfolds. Overall, however, the 10 percent method provides three benefits: (1) an easily applied schedule; (2) the sensible suggestion that it is best to stay roughly within such decrements, even if the first steps turn out to be uncomplicated; and (3) in cases where withdrawal difficulties manifest themselves after most of the dose has been reduced,5 a framework in which the individual can avoid compounding such difficulties by not rushing through the remaining steps of withdrawal.

 

As noted, this method suggests that 10 percent of the initial dose be removed at each step. Thus, a person taking 200 mg of a drug would re¬duce it by 20 mg (10 percent of 200) at each step of the withdrawal.

 

Seven to ten days is a reasonable length for each step if the duration of drug use has not exceeded one year.

  • The first step involves going from 200 mg to 180 mg and taking the latter dose for seven to ten days.
  • The second step involves going from 180 mg to 160 mg, and again staying on this dose for seven to ten days.

The other steps are similar, involving a 10 percent reduction until you are down to 0 mg. However, the very last step may be the most difficult, even if the original amount of the drug has now been reduced by 80 percent or more. In that case, you could reduce the remaining quantity itself gradually. You could progress, say, by 25 percent decrements, over two weeks or more. This would mean, in our example, going from 20 mg to 15 mg, then to 10 mg, then to 5 mg, then to zero. (As described in Chapter 7, some people benefit from prolonged use of tiny doses during the last phase of withdrawal.) Each substep could last four or five days, or more, based on your ongoing assessment of your progress—ideally, validated by feedback from your doctor and from trusted friends or relatives.

How to Divide Dose Reductions During the Day

Perhaps you are taking drugs in divided doses throughout the day. For instance, you might be taking a dose in the morning, at noon, and before bedtime. One way to reduce this kind of intake is to use the 10 percent method to progressively decrease the morning doses until these are eliminated; then move on in a similar manner to the noon doses and, ultimately, to the evening doses.

 

Alternatively, you could reduce the morning dose during the first step of the 10 percent method, then reduce the noon dose during the second step, then reduce the evening dose during the third step. Once this cycle was finished, you would begin the fourth step with a further reduction of the morning dose, and so on, until the withdrawal is completed.

 

Sometimes there will be obvious reasons to choose the morning or evening dose as the first one to reduce. When taking tranquilizers such as Xanax or Klonopin, for example, many people find that they awaken in the morning in a state of anxiety or agitation due to withdrawal from the previous evening dose. Therefore, they may feel more comfortable beginning with a reduction of the afternoon dose. Others may find that they become excessively sleepy in the afternoon. They might want to begin by reducing that dose. Still others may be concerned about difficulty sleeping if they stop the evening dose of a tranquilizer. In that case, they would be wise to begin reducing a dose that is given earlier in the day.

 

There are no hard and fast rules about which doses to reduce first. In general, however, you should consider initially reducing the dose that's causing the most side effects, such as the afternoon dose that makes you too sleepy. Conversely, you may want to initially keep the dose that seems to be helping you the most, such as the evening dose if you have insomnia.

 

How to Fraction Individual Doses

To follow the above steps, you may have to use smaller doses than those written on your prescription. Psychiatric drugs usually come in pills of varying doses, such as 200, 100, 75, 50, and 20 mg. You can request that your pharmacist provide you with pills of different strengths when you are filling your prescription, or help you determine which combinations of existing pill strengths you should use to decrease the dose by as close to 10 percent as possible. Most pills have a slit that allows them to be divided in half easily; you can also purchase a device for cutting pills, which is available at many pharmacies. Capsules, too, can sometimes be opened and their contents divided up. Your pharmacist can inform you about any problems involved in dividing your pills or the contents of your capsules. You should also discuss this process with your doctor.

 

* * *

In sum, the actual process of reducing your drug intake is not inherently complicated. For a prudent, minimal-risk withdrawal, it's a good idea, first, to adapt the withdrawal to your unique circumstances, both psychological and physical. Second, it's a good idea to proceed gradually— for example, by 10 percent reductions every seven to ten days or longer—depending on how long you've been taking drugs. Third, if you're taking several drugs simultaneously, it's best to remove one at a time, again in a gradual manner.

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Very informative article, although it is a day after the fair for us, poor CT'ers... :(

I will include this in the complaint letter I will send to my GP, although I am afraid that it will remain impossible to convince those supported of the flat-earth theory that the Earth in fact is a sphere. ;)

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Seems like a lot of folks find 10% every seven to ten days is actually too aggressive. Still, it's a place to start, and something to show your doctor.

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I'm finding that tapering a little more than 10% works for me; however, I can sense that I have to stay at a new taper at least two months or longer. I seem to start feeling the drop around three weeks in... and it feels to me that I need to give my body several months after that to adjust to the new dose.

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I'm finding that tapering a little more than 10% works for me; however, I can sense that I have to stay at a new taper at least two months or longer. I seem to start feeling the drop around three weeks in... and it feels to me that I need to give my body several months after that to adjust to the new dose.

 

Yeah, bottom line that really is the key--take your time and figure out what works for you.

 

The thing I see getting people in trouble most is tapering too fast at first, and then by the time the w/d kicks in they've already reduced their dose so much they can't get stable again. With benzos this can be pretty serious because reinstating may not work. It sounds like people have better luck reinstating with ADs, but it's still a bummer, because then you have to start the taper over.

 

I taper in a different style, which is very small cuts more often (like 1-2% every few days) with intermittent holds for up to three weeks depending on how my bodymind is responding.

 

I think the most important single factor is paying close attention and learning your own signals that mean it's time to slow down.

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I'm with Rhi, summer. It may be you can make smaller cuts more often. I'm concerned about that long recovery time -- why not make it a little easier with tiny cuts?

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Alto, that was a great read. I found it so helpful that I added it to my website. I don't know much about proper net etiquette, I've never had a website before. Is it okay that I did that? http://paxilwithdrawals.webs.com/taperingoffdrugs.htm

 

I'm not selling anything on my site. I just want the information out there. I do have a link to this website on my page as well.

 

Thank you for sharing this.

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Shanti, See the Read This First forum about using material from this site.

 

Most of the posts I put on this site required a lot of work. If you use material from this site, including the above (which is a selection from Dr. Breggin's work), please credit me and this site as the source.

 

If you post anyone else's material from this site, you'll have to get permission from the writer.

 

Thanks for the pointer to SA. I appreciate your interest in educating as many people as possible.

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Okay, will do. Thank you :)

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I'm curious, why was 10% reductions of the initial dose recommended here instead of the current dose each time?

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If one has been on an anti depressant like Remeron for only two months, the 10% method is still valuable, but would the length of time for each step perhaps be shortened because of the short time one has been on the drug? 

Thanks.

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Hey Boardwalk! I have been tapering off of celexa (citalopram) and I went by ten mg. reductions each month for two months because I wasnt on a higher dose for that long but I will now be slowing to the 10% method from here on out(if I can be patient). Every body is different as is every drug. I would be patient and see if someone with more experience with tapering than I have will come along and give you some good advice. Good luck!

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Hey Boardwalk! I have been tapering off of celexa (citalopram) and I went by ten mg. reductions each month for two months because I wasnt on a higher dose for that long but I will now be slowing to the 10% method from here on out(if I can be patient). Every body is different as is every drug. I would be patient and see if someone with more experience with tapering than I have will come along and give you some good advice. Good luck!

Hi Rubyrddress,

Thanks for your comment.   I originally tapered Xanax and Remeron together and made it to end feeling good, but  then I had a reaction and decided to reinstate Remeron;  at least I got the Xanax out of my system....what a horrible drug.  Anyway,  the Remeron solved some of the anxiety I was feeling.  I have only been on the latest reinstatement for about two weeks, so it's very tempting to reduce faster;  anyhow, I will probably just stick with the 10% reduction and be patient. 

I am anxious because I have to be completely off of the anti depressant before I can begin a natural treatment of kanna.  I've read up on it's benefits and it's truly remarkable with it's results.  Also,  lithium orotate, (NOT lithium carbonate) stimulates serotonin levels but should not be taken while one is taking anti depressants because of serotonin syndrome which I understand is nasty and to be avoided at all costs.

All the best.

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I'm curious, why was 10% reductions of the initial dose recommended here instead of the current dose each time?

 

I also would like to know why a 10% reduction of initial dose is recommended here instead of current dose?

 

I would like to speed up my taper, and if 10% off original dose is recommended, than i would like to do that.

 

Currently i am reducing dose by current dosage.

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You will have to ask Dr. Breggin why his taper is calculated on the original dose. It may be he didn't consider the implications of this: he never helped many people taper.

 

If you do it this way, your decreases become an ever-large proportion of your current dose. If you start at 20mg, at 4mg, a 2mg (10% of 20mg) reduction is 50% of the dosage to which your nervous system has (hopefully) adapted.

 

You might start out slow, but you speed up as you go along. We have many people here who have tried this and developed withdrawal symptoms.

 

Periodic dosage reduction of 10% calculated on the current dose is a much gentler reduction curve than the method Dr. Breggin described above.

 

Read Why taper by 10% of my dosage?

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Do some people have an easier time coming off psychiatric drugs than others? Doesn't it vary greatly?

 

So far i am having no problems, and i am decreasing now at 6% a week.

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It would appear to vary enormously. I read in some success stories they jump off ON A Tablet. I tried to jump off 0.015 (I think) and it was a no go.

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Many people come to the realization that their symptoms and difficulty in withdrawal are not worsening mental illness but due to the drugs themselves when they read this book: Your Drug May Be Your Problem: How And Why To Stop Taking Psychiatric Medications by Peter R. Breggin and David Cohen. Chapter 8, How to Stop Taking Psychiatric Drugs, contains a detailed explanation of why and how to use the 10% reduction method.

 

It is posted here to educate viewers about safe tapering. It answers many questions about why to taper slowly, how to taper slowly, and when to slow down even more. Full text, with notes and bibliography, here.

 

Your Drug May Be Your Problem

Chapter 8: How to Stop Taking Psychiatric Drugs

 

You may feel in a rush to stop taking psychiatric drugs. Perhaps you are experiencing distressing side effects or feel "fed up" with being sluggish and emotionally numb. Beware! It's not a good idea to abruptly stop taking drugs without first making sure that there's no danger involved in doing so. In our opinion, it is almost always better to err in the direction of going too slowly rather than too quickly. In rare cases, the development of a severe adverse reaction may require an immediate withdrawal; but if you are having a serious drug reaction, you should seek help from an experienced clinician.

 

Once you have begun to withdraw from psychiatric drugs, don't let anyone—not even your doctor—rush you. Especially if there's a chance that you are going too fast, pay careful attention to how you feel physically, emotionally, and spiritually. At the same time, however, you should take into account the warnings of professionals, family members, or friends who believe that withdrawal is causing you more problems than you realize. You may not be the best judge of your emotional condition as you come off drugs, so you should take into consideration the concerns of people you trust.

 

Gradual Withdrawal Is Its Own Protection

When people take psychiatric drugs, their decision-making faculties may function less effectively. Their feelings are numbed. At these times, if their thinking were expressed in words, it would likely communicate indecision, apathy, or confusion. Or they may experience different feelings in rapid succession, almost as if they were out of control. Because people generally want to think more clearly, to "feel fully" again, and to be more in control of themselves, they are motivated to stop taking psychiatric drugs.

 

Coming off drugs gradually helps to "contain" the emotional and intellectual roller-coaster that sometimes accompanies withdrawal. Indeed, a slow, gradual tapering serves as a discipline upon the withdrawal process. This discipline is backed by available knowledge and sound clinical experience. In the absence of a trusted friend or ally to provide feedback on your progress, in the absence of a support network, gradual withdrawal is likely to be the wisest strategy—especially if you are unsure as to how quickly you should proceed. Even if a medical doctor or other health professional is assisting you or monitoring your withdrawal, a gradual taper is usually the safest strategy.

 

Why Gradual Withdrawal Is Better Than Sudden Withdrawal

The minute a psychiatric drug enters your bloodstream, your brain activates mechanisms to compensate for the drug's impact.1 These compensatory mechanisms become entrenched after operating continuously in response to the drug. If the drug is rapidly removed, they do not suddenly disappear. On the contrary, they have free rein for some time. Typically, these compensatory mechanisms cause physical, cognitive, and emotional disturbances—which are collectively referred to as the withdrawal syndrome.

 

The simplest way to reduce the intensity of withdrawal reactions is to taper doses gradually, in small increments. This way, you are giving your brain appropriate "time" and "space" to regain normal functioning. Unless it is clearly established that you are suffering an acute, dangerous drug-induced toxic reaction, you should proceed with a slow, gradual withdrawal. The longer the withdrawal period, the more chances you have to minimize the intensity of the expected withdrawal reactions.

 

Interestingly, there is some evidence that "gradual discontinuation tends to shorten the course of any withdrawal syndrome."2 In other words, the actual duration of all expected symptoms from drug withdrawal is likely to be shorter if you withdraw slowly than if you withdraw abruptly.

 

In one early study of withdrawal from tricyclic antidepressants, 62 percent of those withdrawn in less than two weeks experienced withdrawal reactions, compared to only 17 percent of those withdrawn over a longer period.3 Because unpleasant withdrawal reactions are one of the main reasons you might be tempted to abort your withdrawal, a gradual taper increases your chances of succeeding and remaining drug-free.

 

In addition, it appears that people who gradually reduce their drug intake find a renewed vigor and energy that they now can learn to reinvest. In contrast to a sudden, unplanned cessation, a gradual withdrawal allows them to find constructive ways to use this energy, to appreciate the new confidence in their abilities that they will develop, and to consoli¬date the new emotional and behavioral patterns that will be learned in the process.

 

One published account describes the case of a woman who wanted to stop Paxil after taking 20 mg daily for six months. Her doctor abruptly cut this dose in half, to 10 mg daily, and gave her the new dose for one month. Then, during the following two weeks, he gave her 10 mg every other day. On alternate, nondrug days, the woman experienced severe headaches, severe nausea, dizziness and vertigo, dry mouth, and lethargy. The dose was reduced to 5 mg daily but, convinced that this only prolonged her agony, she stopped abruptly. She is reported to have experienced two weeks of various withdrawal symptoms and then to have fully recovered.4

 

A more gradual taper, rather than an abrupt 50 percent reduction at the start, might have reduced the severity of this woman's overall withdrawal reactions. Granted, many users of psychiatric drugs do cease them suddenly, without experiencing any significant withdrawal pains. Our experience, however, suggests to us that abrupt withdrawal is chosen by people who are not properly informed or supervised, who cannot tolerate their drug-induced dysfunctions any longer, or who act impulsively because they perceive that no one is listening to them or understanding their suffering.

 

Remove Drugs One at a Time

Many people, perhaps yourself among them, take several psychiatric drugs simultaneously. Common psychiatric drug combinations include an antidepressant and a tranquilizer; a stimulant and a tranquilizer; lithium and an anticonvulsant; or a neuroleptic, an antiparkinsonian, and a tranquilizer.

 

You can withdraw from several drugs simultaneously, but this is a risky strategy. It should be reserved for cases of acute, serious toxicity. In addition, since drugs taken together (such as neuroleptics and antiparkinsonians) often have some similar effects, withdrawing them together can make withdrawal reactions worse. If you intend to withdraw simultaneously from two or more drugs, you should do so under the active supervision of an experienced physician or pharmacist.

 

When you take two drugs, your brain tries to compensate not only for the effects of each one separately but also for the effects of their interaction. The physical picture gets even more complicated with each additional drug. The increasing complexity goes far beyond our actual understanding, creating unknown and unpredictable risks during both drug use and withdrawal. In cases of multidrug use, withdrawal is like trying to unravel a thick knot composed of many different strings—without cutting or damaging any of the strings. In this analogous situation, you would have to proceed quite carefully indeed, gradually disentangling one string and continually adjusting the others in response to the ongoing progress.

 

It is usually best to reduce one drug while continuing to take the others. The process begins anew once you've eliminated the first drug completely and have gotten used to doing without it.

 

Which Drug Should Be Stopped First?

If you want to get off more than one drug, there are some considerations in deciding which drug to stop first. Let's say you're taking drug "A" to counteract the side effects of drug "B"; in this case, you should probably start withdrawal with drug "B." For example, if you're taking a sleeping pill for insomnia caused by Prozac or Ritalin, you may want to delay withdrawal from the sleeping pill until you have begun to reduce the Prozac or Ritalin. Similarly, if you're taking Cogentin or Artane or some other drug to suppress movement disorders caused by neuroleptics, you should probably first reduce your neuroleptic before you attempt to withdraw from the Cogentin or Artane.

 

Because benzodiazepine tranquilizers often provoke unpleasant, lengthy, and potentially dangerous withdrawal reactions, some people choose to withdraw from their use last, after they've experienced withdrawal from other drugs and strengthened their resolve and gained confidence.

 

The 10 Percent Method

Pharmacy textbooks often describe the 10 percent withdrawal method, especially with regard to benzodiazepine tranquilizers. It may be applied to any psychiatric drug. If you wish to stop taking psychiatric drugs, the 10 percent method (or variations on it) can be a good starting point.

 

This method generally stipulates that withdrawal be carried out in approximately ten steps, or 10 percent at a time. Sometimes, the very last step is itself divided into a series of smaller steps. The duration of each step may vary from a few days to several weeks or months. Thus, if an individual stops a decade-long use of tranquilizers or neuroleptics, each step could sensibly last two or three months, barring any major difficulties. Many older persons have been taking tranquilizers daily for over twenty years. In these cases, a withdrawal period of two years is not unusual.

 

The 10 percent method is not absolute. It should be adapted to individual situations and changing circumstances. As we mentioned, withdrawal needs to be sensitive to each individual's developing situation as the process unfolds. Overall, however, the 10 percent method provides three benefits: (1) an easily applied schedule; (2) the sensible suggestion that it is best to stay roughly within such decrements, even if the first steps turn out to be uncomplicated; and (3) in cases where withdrawal difficulties manifest themselves after most of the dose has been reduced,5 a framework in which the individual can avoid compounding such difficulties by not rushing through the remaining steps of withdrawal.

 

As noted, this method suggests that 10 percent of the initial dose be removed at each step. Thus, a person taking 200 mg of a drug would re¬duce it by 20 mg (10 percent of 200) at each step of the withdrawal.

 

Seven to ten days is a reasonable length for each step if the duration of drug use has not exceeded one year.

 

  • The first step involves going from 200 mg to 180 mg and taking the latter dose for seven to ten days.
  • The second step involves going from 180 mg to 160 mg, and again staying on this dose for seven to ten days.
The other steps are similar, involving a 10 percent reduction until you are down to 0 mg. However, the very last step may be the most difficult, even if the original amount of the drug has now been reduced by 80 percent or more. In that case, you could reduce the remaining quantity itself gradually. You could progress, say, by 25 percent decrements, over two weeks or more. This would mean, in our example, going from 20 mg to 15 mg, then to 10 mg, then to 5 mg, then to zero. (As described in Chapter 7, some people benefit from prolonged use of tiny doses during the last phase of withdrawal.) Each substep could last four or five days, or more, based on your ongoing assessment of your progress—ideally, validated by feedback from your doctor and from trusted friends or relatives.

How to Divide Dose Reductions During the Day

Perhaps you are taking drugs in divided doses throughout the day. For instance, you might be taking a dose in the morning, at noon, and before bedtime. One way to reduce this kind of intake is to use the 10 percent method to progressively decrease the morning doses until these are eliminated; then move on in a similar manner to the noon doses and, ultimately, to the evening doses.

 

Alternatively, you could reduce the morning dose during the first step of the 10 percent method, then reduce the noon dose during the second step, then reduce the evening dose during the third step. Once this cycle was finished, you would begin the fourth step with a further reduction of the morning dose, and so on, until the withdrawal is completed.

 

Sometimes there will be obvious reasons to choose the morning or evening dose as the first one to reduce. When taking tranquilizers such as Xanax or Klonopin, for example, many people find that they awaken in the morning in a state of anxiety or agitation due to withdrawal from the previous evening dose. Therefore, they may feel more comfortable beginning with a reduction of the afternoon dose. Others may find that they become excessively sleepy in the afternoon. They might want to begin by reducing that dose. Still others may be concerned about difficulty sleeping if they stop the evening dose of a tranquilizer. In that case, they would be wise to begin reducing a dose that is given earlier in the day.

 

There are no hard and fast rules about which doses to reduce first. In general, however, you should consider initially reducing the dose that's causing the most side effects, such as the afternoon dose that makes you too sleepy. Conversely, you may want to initially keep the dose that seems to be helping you the most, such as the evening dose if you have insomnia.

 

How to Fraction Individual Doses

To follow the above steps, you may have to use smaller doses than those written on your prescription. Psychiatric drugs usually come in pills of varying doses, such as 200, 100, 75, 50, and 20 mg. You can request that your pharmacist provide you with pills of different strengths when you are filling your prescription, or help you determine which combinations of existing pill strengths you should use to decrease the dose by as close to 10 percent as possible. Most pills have a slit that allows them to be divided in half easily; you can also purchase a device for cutting pills, which is available at many pharmacies. Capsules, too, can sometimes be opened and their contents divided up. Your pharmacist can inform you about any problems involved in dividing your pills or the contents of your capsules. You should also discuss this process with your doctor.

 

* * *

In sum, the actual process of reducing your drug intake is not inherently complicated. For a prudent, minimal-risk withdrawal, it's a good idea, first, to adapt the withdrawal to your unique circumstances, both psychological and physical. Second, it's a good idea to proceed gradually— for example, by 10 percent reductions every seven to ten days or longer—depending on how long you've been taking drugs. Third, if you're taking several drugs simultaneously, it's best to remove one at a time, again in a gradual manner.

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Hey alto, great book here by dr. Breggin. How can I download more books of him? Do you have a link to psychiatric drug withdrawal for example ?

Thank you

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You could try your library.

 

There are videos on Youtube.  I have a list on my website (in signature).

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I would like to taper according to Dr. Peter Berggin's plan only!!!
 
I suffer from severe side effects with Lexapro and can not make a very slow taper
 
The recommendation you brought in Peter's forums here is to taper 10% every week in case I took a med for 1 year 
 
What does he say by chance that I took a 10-year medication?

is there answer for that in his book?
 
Thank you

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Actually, the 10% recommendation is an old guideline that has been passed on from one generation to another generation of psychiatric survivors, and it wasn't exclusively created for antidepressants. As I recall reading, that rule may have had its beginnings in the 60's and 70's, long before the newer psych meds hit the market.

 

As far as how frequently those reductions need to be made, it depends on many factors....

 

Also, sometimes, it is hard to say what is a side effect vs a discontinuation effect. A lot of times, people experience both, so it's important to listen to your body closely and determine the difference.

 

 

 

*** I am not a doctor and this is not medical advice  ***

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I would like to taper according to Dr. Peter Berggin's plan only!!!
 
I suffer from severe side effects with Lexapro and can not make a very slow taper
 
The recommendation you brought in Peter's forums here is to taper 10% every week in case I took a med for 1 year 
 
What does he say by chance that I took a 10-year medication?

is there answer for that in his book?

 
Thank you

 

 

Lorin,

 

Did Lexapro cause you issues that you didn't have with Zoloft, or did you have to taper Zoloft  because it was causing issues?

Or was the Zoloft taper your decision to be free of antidepressants?

 

I've not read Dr. Breggin's book "Psychiatric Drug Withdrawal", but I am sure it has some really good information in it.

I am not sure that Dr. Breggin has helped many people taper. He's extremely knowledgeable of the long-term effects of different psych meds, and understands what they do, but his work has been mostly in warning people of dangers of these psych meds, treating his patients without meds, as well a being an expert witness in many court trials where psychiatric medication played a significant role in what was going on.

 

I read his book "Talking Back to Prozac" about a year after I started taking Prozac, and I really appreciated the information in the book and seriously thought about stopping, but I don't recall finding any specific information about actually stopping Prozac. Perhaps, if I'd found his book BEFORE starting Prozac, there's a chance I'd never taken it, but once I started taking it, I had these 20mg capsules I was being prescribed and didn't have any knowledge of tapering medications, which I don't think was discussed in the book, either. Maybe the new editions of it have more information on the subject.

 

Honestly, Prozac was the only antidepressant that actually agreed with me (I tried Effexor, Zoloft and then later Lexapro with poor results), and it's probably why I stayed on it so long. But, yes, I felt like it turned into a placebo after about 10 years on it.

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hi i try to back to zoloft wile on lexapro and the side effect worst
i was on zoloft in the past 8 years and was ok 
i think it did me side effect with my stomach and i didnt knew antill i got lexapro
now taper 30% every 3 weeks becouse i suffer from the stomach so mach
i wish i could taper slowly

did you ct prozac?
in my country the dr suggest to taper 1/4 every 2 weeks
i didnt hear about the  10% method in my state 
for me its new

 

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Hi Lorin! I have been using Dr. Breggin's taper method since last summer. Things have been going well. I am now down to 25mg of celexa from 60mg. I tried to deviate from his method and go a little faster, but with disasterous results. I have been sticking with the 10% method and I even go more than a month for each stepdown depending on how I feel. I think it is a good method for me and SLOW and steady wins the race! Good luck!

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I would like to suggest that the 10-percent method should be used with a keen awareness of the half-life of the medication. Tapering off valium using the Ashton Method, for example, allows one to take the meds three times per day, taper down and eliminate the morning and afternoon dosage one at a time - but this is because valium has an extremely long half life and the drug stays in the system for days. On the other hand, tapering to eliminate a morning or afternoon dose of a short half-life drug, such as Neurontin, can be disastrous, as I discovered recently. The person I care for is tapering off this drug (generic name, gabapentin) and got all the way down to the last taper, only an evening dose, when disaster struck and she had off-the-wall withdrawal reactions. We had to kick her back to three doses a day and then taper each dose using water titration. This may vary with different types of medications, but I'd suggest that the half-life of the drug is very important for a successful taper.

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