Musiclover: would really like to find my way off meds but hard to imagine it

May 14

How do you start a post with ‘@the member’s name’? I can’t see how to do that.

Anyway, thank you FindRest and there really is no need to apologise. I am sorry but I am going to have to defer replying properly once again as it is very late at night here. I will come back to this tomorrow.

May 15

No need to reply.

To tag someone, type the @ sign then immediately start typing the name of the member, without any spaces. Then select the name from the drop-down menu that pops up. for example: @Musiclover (Here I just typed @ and the letter M. Your name popped up and I selected it.

May 15

10 hours ago, Musiclover said:

Notwithstanding the fact that my healthier mental state is no doubt mostly due to the meds, which is why I do fear coming off them in case I go back to how it was.

I think, this is another good reason to keep it slow. If you believe the meds are helping you, but at the same time you fear they are harming you, a first reasonable approach might be to try to find the lowest dose/drug level that still helps. You thus might not avoid any harm at all, but you will probably find the optimal trade off between harm and help. The best way to do this is slowly, carefully evaluating every step as you go (which is probably a hard thing to do with health anxiety). Maybe an intermediate goal (only for motivation) could also be 0mg Olanzepine, 75mg Venlafaxine and 15mg Mirtazapine.

If I remember correctly, last time you reduced Olan by 50%, stayed there for a week and then went to 0 and afterwards got into trouble. You then wondered if the trouble came from the first reduction or the second. The answer is you cannot know and this is not a case of delayed onset of withdrawal. Olanzepine has a half-life of 20-40 hours. When you are older and your metabolism slows, the half-life is probably even longer. Thus it takes probably at least a week, maybe also 10 days until the drug level in your system reaches a stable state, after you changed your dose. It then may take further days for your body and nervous system to react. Depending on how experienced you are at noticing those reactions it may take another couple of days until you become aware if something went into the wrong direction. I would say that a 50% reduction is too fast/too much under any circumstances (apart from life threatening adverse drug reactions) and it is wise to have holding times of at least 3 weeks during each reduction step. Since reducing your drugs is a pretty frightening thing, I would start this process very slowly. Even without experiencing physical withdrawal, it can psychologically send you into crisis. If you start slowly and things work out and you feel comfortable, you could try to speed up a little...and carefully see how it works out.

P.S.: Again only for motivation...if you do 10% every month, you roughly half a dose within 6 months. So within 2 years you might get down to 75mg Venlafaxine and 0.3mg Olanzepine. In the "endgame thread" it is recommended to get below 2.5% of the prescribed dose before jumping to zero. It is unclear to me what that means when you started on a lower dose than usually prescribed. As far as I know Olanzepine is usually prescribed at 5-10mg per day. So assuming 10mg as reference you would be very near "jump off territory" at 0.3mg. If 5mg is the reference, you might have to give it another 6 months. Anyways getting to 0mg Olan and 75mg Venla is probably doable in the forseeable future.

May 15

@FindRest Ah right, I've got it - thanks for explaining!

No I would like to reply, if you don't mind indulging me. I said there was no need to apologise because I know you posted in the spirit of offering help. You weren't to know my particular sensitivities. As it happens, I wasn't aware that Venlafaxine could also raise cholesterol because I didn't research it, preferring at the time to remain naive about most of the side effects. Now that makes sense as to why there has been a steady increase since I started on it. The strange thing is that the psych. clinic I was attending tested for the effects of being on Olanzapine on a yearly basis - bloods, weight, ECG and blood pressure, but they didn't do it for the other drugs. Plus the psychiatrist did not mention cholesterol when I asked him what side effects to expect from V. Anyway, it is my responsibility to be informed about these things, not anyone else's as the information is all out there. Now that I know I am more motivated to get off but it will take a long time to get around to V. if I start with O.

Thank you for sharing something of your story. That sounds very difficult and no doubt frightening at the worst times. I hope things are better for you now. Yes I am in a better position to start tapering soon and I am sure that is the path I will choose, when the time is right, as I am just now in the somewhat stressful process of winding down my business of 40 years leading up to retirement in August p.g.!

Anyway, no harm done apart from raising my anxiety about V., which I am sure will actually serve me in the end in terms of awareness/choice/empowerment. Hopefully..

@Alfred1977 Yes slow and steady but at this point I think I will be aiming to be drug-free eventually. I am however open to discovering that I might need a maintenance dose, for a time anyway. I just hope that doesn't turn out to be on the high side. I am feeling hopeful but then I haven't started the taper yet. I am drawn to the 'harm reduction' approach but I will have to see how I get on and I agree that anxiety might make it difficult to evaluate what happens objectively. I am sure that I came off O. too quickly before and it caught up with me - your explanation is very helpful thanks. As is the time scale and the possible reduction scenario. I understand that you have to do it one drug at a time. So that means I would start with O. and only after that is right down and I am still ok, then start on the 2nd drug. Same for the 3rd one. And the suggested order would be O., then V. and hold the M. at the current level? I think I can aim for that, as a first step anyway. I imagine that if I feel encouraged at that stage I will probably want to go the whole way but I'll deal with that when/if I get there.

I can't understand how doctors and psychiatrists remain ignorant about the need to taper slowly. Surely they see enough of the effects of coming off at their suggested rates? As someone once said to me, an alternative practitioner as well as an MD, doctors get lots of training about how to put people on drugs but almost none about helping them come off. The cynic in me would suspect a bias towards priming the pharmaceutical industry but I don't really believe that is the prime motivator. I believe most medics are genuinely trying to help, even if they have a limited viewpoint and a biochemical bias.

May 15

Hi @Musiclover- just catching up a bit here. Health anxiety must be terrible. I've had all sorts of anxiety issues over the years, but health anxiety is not something I've experienced, despite working in intensive care for 25 years! There's so much information out there now, and I can totally see how that could be overwhelming and terrifying for some. And the fact that we clearly cannot rely on our doctors to have the most accurate information about some things must add fuel to the fire.

I think you are in an amazing spot right now in terms of not being in severe crisis from a cold turkey stop or something. You are doing your research in order to prepare for a proper taper. These are all good things... things that I wish I could have done prior to my first cold turkey stop back in the 90s! Now might be a good time for you to dig deep, and figure out where this health anxiety originated. No one is born with health anxiety- that comes from life experience somewhere along the line. Personally, I've found that really understanding my origin story, and how I ended up here in the first place has been so empowering. It's like all the puzzle pieces have fallen into place, and it has allowed me to have such deep compassion for the younger me, who was terribly damaged and had no coping skills.

I would also say that, right now, creating some good habits with respect to self care and managing anxiety without drugs would be a tremendous help to you in the long run. I do think that tendency to anxiety runs strong in some of us, and going off meds without a backup plan is a great way to end up right back on the drugs. I'm a huge fan of progressive relaxation, walking meditation, comforting rituals (I like my tea, my cat and a good book, all at once!), gentle exercise, deep breathing. These things help get me through the tough moments, even if it can be hard to engage with them when I'm out of my mind with anxiety. Recovery is HARD WORK, but we are all so much stronger than we give ourselves credit for.

Hang in there!

May 15

@Catwoman73 Yes health anxiety has been a struggle in one shape or form most of my life; even if for long stretches (decades) it wasn't consciously an issue, it always lurked in the background. I can imagine that working in an ICU could either inflate that if it was a tendency, or actually serve to build more resilience - a kind of 'exposure therapy' maybe? Anyway, as I said before I have done many years of therapy and have a good understanding of where my fears come from in terms of early deficit and trauma but what 'attacked' me a few years ago was a powerful upsurge of those fears accompanied by very distressing physical symptoms and that experience seemed to lead to a profound general depression, where everything was tainted by anxiety and dread. I tried to tackle it in the ways I knew how but nothing helped. It's hard to explain but the experience was so visceral, physiological and overwhelming that no amount of talking or insight made a dent in it. I also experienced almost no control over what was happening inside me. I suppose I had a 'breakdown' really where my old coping strategies failed and, to quote Robert Bly, "all the demons came rushing in". What my unconscious was up to I do not know but it was some sort of seismic shift in my psyche which I simply had to endure. I hope I don't have to go back into that when the medications no longer protect me from those demons.

In terms of self-care, I do already have a range of practices that have been with me for many years. Relaxation technique, meditation, Qigong, journaling, music, walking in nature etc. etc. I've done and continue to do it all. And yes, some of those things have been of help, though sadly it was only the medication that had the clout to really alter my experience and give me some relief.

I think you are right about having more strength than we realise. I quite honestly don't know how I survived that nightmare but somehow I got through it, with the help of medication but not just that. Some sort of inner strength as well. So I don't mean to dismiss what you are suggesting, I just honestly don't know what else I could do to either understand more about what happened, or to manage my self-care while I go through whatever is down the line. However I will take it on board and consider some form of therapy or at least self-reflection again and build in some more supports along the way, especially if I am going to taper off. The problem with therapy is it is so expensive and given I am about to retire, I will have less funds available. Anyway, all food for thought so thank you.

May 15

3 hours ago, Musiclover said:

@Catwoman73 Yes health anxiety has been a struggle in one shape or form most of my life; even if for long stretches (decades) it wasn't consciously an issue, it always lurked in the background. I can imagine that working in an ICU could either inflate that if it was a tendency, or actually serve to build more resilience - a kind of 'exposure therapy' maybe? Anyway, as I said before I have done many years of therapy and have a good understanding of where my fears come from in terms of early deficit and trauma but what 'attacked' me a few years ago was a powerful upsurge of those fears accompanied by very distressing physical symptoms and that experience seemed to lead to a profound general depression, where everything was tainted by anxiety and dread. I tried to tackle it in the ways I knew how but nothing helped. It's hard to explain but the experience was so visceral, physiological and overwhelming that no amount of talking or insight made a dent in it. I also experienced almost no control over what was happening inside me. I suppose I had a 'breakdown' really where my old coping strategies failed and, to quote Robert Bly, "all the demons came rushing in". What my unconscious was up to I do not know but it was some sort of seismic shift in my psyche which I simply had to endure. I hope I don't have to go back into that when the medications no longer protect me from those demons.

In terms of self-care, I do already have a range of practices that have been with me for many years. Relaxation technique, meditation, Qigong, journaling, music, walking in nature etc. etc. I've done and continue to do it all. And yes, some of those things have been of help, though sadly it was only the medication that had the clout to really alter my experience and give me some relief.

I think you are right about having more strength than we realise. I quite honestly don't know how I survived that nightmare but somehow I got through it, with the help of medication but not just that. Some sort of inner strength as well. So I don't mean to dismiss what you are suggesting, I just honestly don't know what else I could do to either understand more about what happened, or to manage my self-care while I go through whatever is down the line. However I will take it on board and consider some form of therapy or at least self-reflection again and build in some more supports along the way, especially if I am going to taper off. The problem with therapy is it is so expensive and given I am about to retire, I will have less funds available. Anyway, all food for thought so thank you.

I hear you on the expense... I'm on disability, and making 50% of my usual salary. It's rough. If you do decide to try therapy again, try something different! I'm currently doing EMDR and IFS, and have found it quite helpful for trauma. I totally get what you mean about all the demons rushing in- I've had that experience myself. I think in those situations, short term medication IS helpful. I'm not anti-medication at all- there are situations where they are necessary. There was one occasion in my life where I truly think the medication was the right answer for a time, but in hindsight, I should have been on it for a matter of weeks, not years. And one other time that I definitely should have been on medication due to a full-blown psychotic break, but did not take anything. That was the hardest time I have ever endured... yet I somehow got through without meds. I lean on that when I have a rough day, knowing that I CAN endure pretty much anything.

I know you aren't being dismissive of what I'm saying- it's very tough when everything you thought would help you just doesn't work. I've been there- it's a very helpless feeling. It all comes down to you weighing what you are willing to live with, right? If you stay on the meds, your psychological symptoms will stay in check, but there are some physical health risks. If you choose to taper off, there are some psychological health risks, but you will have a better shot of getting the physical health concerns in check. There's no right answer here- only what is right for you!

May 16

15 hours ago, Musiclover said:

I understand that you have to do it one drug at a time. So that means I would start with O. and only after that is right down and I am still ok, then start on the 2nd drug. Same for the 3rd one. And the suggested order would be O., then V. and hold the M. at the current level?

Since I am not on multiple drugs, I haven't thought about that too thoroughly. I think the idea is that the strain of multiple reductions could add up and if you experience symptoms you don't know which drug caused them. Switching the drugs that you reduce is probably ok. Maybe it can even ease the strain and give more time for certain parts of you nervous system to heal. However switching too often may make it more difficult to learn reading the reactions of your body...especially in the beginning.

You should probably prioritize reducing the drug that is supposedly causing the most trouble/harm at the moment and keep the drugs that are helping at the moment. I don't know much about Olanzepine, but I think you said yourself that it was your first concern because of cholesterol. I haven't heard any good about antipsychotics and so intuitively I probably would want to get rid of this first as well. Why did you doctor prescribe Olanzapine?

Venlafaxine is an energizing drug. If you feel like running out of steam, you might wanna pause reducing it. If you feel wired and have difficulties with sleep, you might wanna reduce it.

Mirtazapine is sedative and thus it is the other way round. If you sleep well, feel tired all day and eat too much, you might wanna reduce it. If you sleep badly stop reducing it.

I think in general sleep is more important than energy.

May 16

@Catwoman73 If I go back to therapy it would probably be Jungian or maybe psychodynamic. I tried a more cognitive approach and another 'process-oriented' one but neither helped. I really resonate with the 'weeks not years' thing - I'm sure that's true for me too but what I've discovered is that they leave you on these things indefinitely and then it's pretty much up to you to find a way off. Shocking really. Good to hear you got through your psychotic break, sounds pretty horrible but as you say at least you know you were able to survive that.

Yes you pretty much summed up my dilemma there in terms of pros and cons but I do think my strong preference is to become medication-free if at all possible. Every day I think about the medication and how being on it still feels so alien to me as I've always avoided meds of any sort whenever possible and reached for them only as a last resort, always preferring alternative/natural approaches. Now look at me on 3 drugs! At least now I feel good about the possibility of reducing them because for a long time I felt trapped on and by them, possibly for life.

@Alfred1977 I've read a fair amount here that advises one drug at a time. I think that seems simplest, although I was warned in an earlier post about the California R. F. combo and how that might be tricky to taper. I guess I'll have to try it one at a time and see what happens. I do think Olan. has to be the first to go. Ven. is the big one in my case so I'm thinking I will leave that til last, though I hear what you're saying about prioritising sleep and I agree. In fact that's how the whole horror started - one night that I didn't sleep at all with anxiety and then that became the norm for ages. At least the 15mg Mirt. has helped with that, probably the Olan. as well. My plan at the moment, unless I come across any reason not to, is to come off the Olan. and Mirt. first (one at a time) and then tackle the Ven.

The second psychiatrist I saw suggested the Olanzapine because it is apparently used quite a lot here at small doses alongside AD's to treat anxiety, especially the crazy anxiety-driven thoughts that crowd in and I was certainly experiencing those, to a pretty horrifying degree. The GP who referred me to her had also mentioned using an anti-psychotic. Ah if only I could go back to before I started any meds. I would give things like CBD oil or St. John's Wort a try first. However I felt too unwell to do anything except rely on my doctors' advice. And now I have to face the long haul of undoing the damage tiny bit by tiny bit..

May 16

6 minutes ago, Musiclover said:

I do think Olan. has to be the first to go. Ven. is the big one in my case so I'm thinking I will leave that til last, though I hear what you're saying about prioritising sleep and I agree.

You will find the way that works for you.

9 minutes ago, Musiclover said:

Ah if only I could go back to before I started any meds. I would give things like CBD oil or St. John's Wort a try first. However I felt too unwell to do anything except rely on my doctors' advice. And now I have to face the long haul of undoing the damage tiny bit by tiny bit..

Yep, the moment I started Venlafaxine over 18 years ago was a fateful moment. I wish I could undo it. Well...you never know what would have happened and maybe God had a plan...

What's extreme in your case is that you were put on 3 drugs. Did you get them all at once or did they try one at first?

May 16

@Alfred1977 Yes maybe our suffering was somehow meant to be. Still, it's hard not to regret past 'mistakes' but little point in doing so, unless to find more resolve in the future.

3 hours ago, Alfred1977 said:

What's extreme in your case is that you were put on 3 drugs. Did you get them all at once or did they try one at first?

First I was put on Mirtazapine. Then about 8 months later Olanzapine was added for the reason I explained above. Finally Venlafaxine was added over a year later but that psychiatrist had been trying to convince me to go on an SSRI for many months as he felt a 'first line approach' had yet to be tried. I finally agreed so he put me on Lexapro, to which I had a bad reaction so we discussed an SNRI and once again I eventually agreed to try Ven. I was afraid of Serotonin Syndrome for a long time from combining either of those with the Mirt. but I went ahead anyway. That finally turned things around and I felt much better. Fast forward to today.

May 18

On 5/16/2024 at 9:11 PM, Musiclover said:

First I was put on Mirtazapine. Then about 8 months later Olanzapine was added for the reason I explained above. Finally Venlafaxine was added over a year later but that psychiatrist had been trying to convince me to go on an SSRI for many months as he felt a 'first line approach' had yet to be tried. I finally agreed so he put me on Lexapro, to which I had a bad reaction so we discussed an SNRI and once again I eventually agreed to try Ven. I was afraid of Serotonin Syndrome for a long time from combining either of those with the Mirt. but I went ahead anyway. That finally turned things around and I felt much better. Fast forward to today.

Don't know much about Olanzapine, as I said, but I think it's usual indication is psychosis and bipolar disorder and stuff like that. I think it is not officially recommended for anxiety and insomnia. Your doctor seems to think that those meds come with basically no risk.

I really wonder how large the percentage of patients is that have to struggle with physical dependence and prolonged withdrawal resulting from those meds. On the one hand we might be biased experiencing so many cases clumped up in these online communities. On the other hand almost everybody here tells the story that their withdrawal was dismissed as relapse by their doctors and there might be a lot of cases of withdrawal out there that remain unrecognized.

I think this uncertainty is pretty frightening and threatening for psychiatrists. If it should turn out that physical dependence and withdrawal is quite common, the use of those meds could get restricted to the most severe cases and 50% or whatever of psychiatrists possibly had to shut down their business. In my experience most of what they do is prescribing meds.

What did your doctor tell you when you tried to quit Olanzapine and had trouble?

May 18

2 hours ago, Alfred1977 said:

What did your doctor tell you when you tried to quit Olanzapine and had trouble?

Yep - I asked him could I be experiencing withdrawal and if so should I give it a couple of weeks to see if it passed but he said no, it wasn't withdrawal but a re-assertion of the depression! A really lovely guy but this fits with what you are saying most people report.

The GP I saw at the time as well as the psychiatrist he referred me to (a very kind but pretty determined young woman) suggested adding the small dose of an anti-psychotic to the Mirtazapine. Maybe it's something more common here, I'm not sure. I have seen reference to it for helping with sleep though, the 15mg of Mirt. also for that purpose. You're right about psychiatrists mostly prescribing and yes, the pharmaceutical industry and doctors generally work hand-in-hand so it would be disastrous for them if people took less of these drugs. Our pharmacists, again lovely people, are delighted I'm sure at one level to see the likes of me coming in every month to order my expensive prescription!

I really liked your former signature btw, the part about doctors prescribing and then us being left filing down pills or falling into the abyss (something like that). Not that there's anything wrong with the current one.. 😉

May 18

17 minutes ago, Musiclover said:

I really liked your former signature btw, the part about doctors prescribing and then us being left filing down pills or falling into the abyss (something like that). Not that there's anything wrong with the current one.. 😉

Yeah, you are right I should put that back into my signature...😉

May 18

35 minutes ago, Alfred1977 said:

Yeah, you are right I should put that back into my signature...😉

Glad you did! 👍

May 24

My scales arrived today. I'm going to start my taper off Olanzapine soon and will post my intended method (cutting, weighing and maybe filing tablets) just to make sure I'm doing it right. Unfortunately I've contracted Covid and so I will wait until that has passed before I start as I'm not in the right frame of mind to take it on.

May 25

Hey @Musiclover,

nice to hear from you. Have you found somebody here that has a lot of experience with dosing Olanzapine and talked with him? I think this would be a good idea.

As far as I know affordable scales have an accuracy of about 0.4mg, which means that in your target range of 0-2.5mg you can get errors of 20-100% of your target dose.

I found also very interesting what Rhiannon (SA veteran with lab skills) said about this subject. She said in some thread that it's more important to dose precisely than to dose accurately. This is supposed to mean that your way of dosing should repeatedly produce the same amount of the drug (precision) and that it is not so important to measure/know exactly how much that is (accuracy) - I guess at least as long as it is somewhat accurate and not totally off. But I think this makes sense. Particularly since it's more important to listen to your body when tapering instead of strictly adhering to some plan.

I don't know if you can do this with a scale alone.

Olanzapine is supposed to solve badly in water, but so is escitalopram for example. I know someone who is making a suspension out of escitalopram tablets and says it's working well. But I guess it would be best to talk to people who actually tapered low doses of Olanzapine for a couple of years.

May 25

@Alfred1977 Hi and thanks for that info. Ok I will do a search for someone with experience of tapering Olanzapine. I know Erimus posted a link earlier in the thread about tapering off it so maybe I'll start with whoever that was.

The scales I bought were affordable yes but a couple of people had left reviews saying it had worked well for tapering off meds. Though a couple of others were not so positive. The reviews for all the affordable ones were a bit mixed though so I just chose the one that seemed the best. I did read that Rhiannon thread but thanks for explaining what she meant by accuracy vs. precision, that's clearer now. I would prefer the dry weighing method than making a suspension as the latter seems quite complicated, from what I've read anyway. So I'll see how I get on with the scales. Meanwhile I'll touch base with an Olan. taperer if I can find one.

May 25

43 minutes ago, Musiclover said:

I did read that Rhiannon thread but thanks for explaining what she meant by accuracy vs. precision, that's clearer now.

Wow...you are already well informed. If you know how it works well, please tell us. I am always interested in learning something new.

May 25

22 minutes ago, Alfred1977 said:

Wow...you are already well informed.

I think that thread was one of the ones Erimus posted way back but yes I've been doing my homework! I intend to read through all the stuff on scales and weighing etc. again though before I start. Sure, I'll let you know how I get on - thanks for the interest.

May 25

7 hours ago, Alfred1977 said:

Olanzapine is supposed to solve badly in water, but so is escitalopram for example. I know someone who is making a suspension out of escitalopram tablets and says it's working well. But I guess it would be best to talk to people who actually tapered low doses of Olanzapine for a couple of years.

I'm currently tapering from escitalopram, and it really doesn't dissolve super well in water. But I make my suspension with half water, half maple syrup. Since the maple syrup is more viscous, the drug particles tend to stay suspended better, creating increased accuracy. And it tastes better lol. That might work for olanzepine as well, if you were to choose to make a suspension. I still don't entirely trust myself at really low doses though, so I will move to using a compound pharmacy when I get below 5mg. Maybe sooner.

May 25

10 minutes ago, Catwoman73 said:

I still don't entirely trust myself at really low doses though, so I will move to using a compound pharmacy when I get below 5mg.

We don't have compound pharmacies in this part of the world unfortunately. I think I'm going to see how I get on with a pill cutter, the scales and maybe a nail file before I go down the suspension route. Unless further reading suggests otherwise..

May 28

So I ran a couple of tests on my scales using some small Propranolol tablets that I had lying around, similar in size to the Olanzapine ones, and I was able to reduce them with a nail file to 10% of their original weight. The scales seem to be pretty precise as far as I can tell with only tiny fluctuations in weight, like .001/2 g between tests. I have to calibrate them a few times during use and I can't breathe on them or anything as they are so sensitive. So I will wear a face mask while weighing. I think this level of precision will suffice, hopefully anyway. As I go to smaller and smaller amounts it might prove more difficult but I've just ordered a pack of 5 weights from 1-20 gram which I plan to use to bring the scales into their best operating range, as suggested by Autostrata in the thread on using scales.

I'm going to file down a few of the Olanzapine tabs tonight and get started on my taper! I will be taking it slowly and carefully while keeping in mind the "harm reduction" advice, again from Autostrata, in the 'why 10%" thread about speeding up the taper if I have no noticeable withdrawal symptoms after a couple of months. I know, I will be very careful about this and will observe myself closely and back it off if it's not working. I did read through the "tips for tapering off Olanzapine" thread but I haven't reached out personally to anyone who has tapered it - I prefer to just get my own process up and running and see how I get on. You can get too much of other people's experience sometimes which can end up making things more difficult, or more anxiety-provoking. That's what I find anyway, though of course some of it can be very helpful. A matter of balance.

So wish me luck as I embark on this journey. I feel positive and hopeful about it, also quite nervous. Which is why I'd better get on to filing those tablets rather than distracting myself by writing this post!

May 28

On 5/25/2024 at 5:00 AM, Alfred1977 said:

As far as I know affordable scales have an accuracy of about 0.4mg, which means that in your target range of 0-2.5mg you can get errors of 20-100% of your target dose.

Alfrd1977, I may just be having a senior moment right now, but I’m not quite understanding how you came up with the % of error. A dose of 2.5mgai will weigh much more than 2.5mg. However, I think my brain fog might be getting the best of me today and that is why I’m not understanding how .4mg variance can give you an error of 100% your target dose. My scale, the Gemini scale, is said to be accurate up to .004g or 4mg. One of the pills I am tapering is .101mgai in dose but weighs 36mgpw. (mgai = mg active ingredient; mgpw = mg pill weight).

I use the scales recommended here and have always felt that as long as I’m consistent in weighing my dose the same way with the same scale, then I’m OK. It’s worked out well for me. Similar to what you both said above.

@Musiclover I do the same thing by adding a 5mg weight to my pan. Sorry you have covid. I had to take a 3-month break to recover from it. Tried tapering at something like 6 weeks after my symptoms went away, but that was too soon. I had one of the first strains that was known for its severity; the newer strains may not require such a long hold. However, you might want to make sure you wait an extra couple of weeks after you think you are fully healed before trying your taper.

Edited May 28 by FindRest

May 29

6 hours ago, FindRest said:

Alfrd1977, I may just be having a senior moment right now

I appreciate learning things from you.

6 hours ago, FindRest said:

A dose of 2.5mgai will weigh much more than 2.5mg. However, I think my brain fog might be getting the best of me today and that is why I’m not understanding how .4mg variance can give you an error of 100% your target dose. My scale, the Gemini scale, is said to be accurate up to .004g or 4mg. One of the pills I am tapering is .101mgai in dose but weighs 36mgpw. (mgai = mg active ingredient; mgpw = mg pill weight).

I didn't know that. Regarding Venlafaxine I somewhere read that the microbeads containing 75mg ai weigh around 90mg (don't know if that is correct but I guess so far I supposed that it is). This would still somewhat reduce the percentage error but in principle I think that in this case a scale error of 0.4mg would throw you off too far at low doses. However in your example you are right. If 0.101mgai are evenly distributed among 36mgpw an error of 0.4mg would only be marginal.

I haven't thought about that and it seems to be an important point when considering weighing as an option. Besides the accuracy of the scale the quotient of active ingredient weight to pill weight matters too. Which raises the question how to get the pill weight before deciding to buy a scale. Another question would be if those scales consistently produce the same error (regarding the importance of precision vs accuracy...on a second thought probably they can't and won't).

Edited May 29 by Alfred1977

May 29

8 hours ago, Musiclover said:

So wish me luck as I embark on this journey. I feel positive and hopeful about it, also quite nervous. Which is why I'd better get on to filing those tablets rather than distracting myself by writing this post!

Good luck! 🙂

May 29

2 hours ago, Alfred1977 said:

I didn't know that

Both tablets and beads have filler in them, regardless of what AD or other drug one takes. It’s easy to calculate the amount of AI in a dose once one weighs the beads in a full capsule (avg several capsules) or weighs their tablets.

2 hours ago, Alfred1977 said:

Regarding Venlafaxine I somewhere read that the microbeads containing 75mg ai weigh around 90mg (don't know if that is correct but I guess so far I supposed that it is).

It will depend on what brand as well as the place of mfg. This is why it’s important for everyone to weigh their own and do their own calculations, as well as to tell their pharmacy not to change manufacturers. I’m currently on name-brand Effexor and take 8 beads (3s+3m+2L). They weigh 9mg on the scale but equal only 2.4mg in active ingredient (my official dose).

2 hours ago, Alfred1977 said:

Which raises the question how to get the pill weight before deciding to buy a scale. Another question would be if those scales consistently produce the same error (regarding the importance of precision vs accuracy).

One doesn’t need to know the pill weight before buying a scale. What’s important is to get a decent brand (Gemini, for example) and to get one that weighs to .001g or 1mg. Few people can readily afford to buy a good one that weighs to .0001g. Almost all of the mg scales I’ve seen weigh to an accuracy of 2-4mgpw. I add a 10g weight to my pan before weighing my dose. That 10g weight helps insure a better accuracy, even when weighing a dose a bit below 2-4mgpw. However, once I get that low (at about 1mgai), I probably won’t be weighing anymore and just count instead. I am both weighing and counting beads at the same time now because I am being extra cautious with my level of sensitivity.

To help produce consistent results, I recalibrate my scale each day I use it and sometimes multiple times during one session (I make several weeks worth at a time). I then turn my scale off, place the pan on the scale and turn it back on (which tares it at the same time). I then place a 10g weight in the pan and note the weight (it very seldom equals exactly 10g). I then add my dose to the pan (so pan now contains the 10g weight and my beads). My goal is to get to my target weight. In this case, I know from experience that my 8 beads in those sizes should weigh 9mg. I make sure to subtract the 10g weight off the amount.

I know this is hard to process as it all gets confusing until one sits down in front of the scale and plays around. It quickly starts making sense. Plus, everyone has their own methods. This is mine. It’s served me well these past 4 years. Ugh.

I hope this helps you too @Musiclover.

Edited to add: Just checked my Gemini scale and it says it has an accuracy down to .002g or 2mgpw. I believe SA suggests to be cautious below 4mgpw.

Edited May 29 by FindRest

May 29

1 hour ago, FindRest said:

Just checked my Gemini scale and it says it has an accuracy down to .002g or 2mgpw. I believe SA suggests to be cautious below 4mgpw.

Do you know what accuracy of a scale precisely means? Could 2mg accuracy mean you have 1mgpw on your scale and it is showing 3mg, i.e. the result can differ by up to 2mg from the true weight? So far I supposed that scale accuracy means that and I found one promoted with 0.4mg accuracy for about $50 or maybe also $70. But I don't know if that is a realistic price. Possibly a working scale with that accuracy costs rather $400-500.

1 hour ago, FindRest said:

They weigh 9mg on the scale but equal only 2.4mg in active ingredient (my official dose).

Then the true weight would be somewhere in between 7-11mg? This would reduce the percentage error by a factor of about 3-4. But still as you get smaller and smaller the percentage error will rise.

Let us say mgpw/mgai=3.75 and scale accuracy 2mg. Further let's say you want to keep the error below 10% of your target mgai dose. Then at 5.33mgai you should stop weighing. For example at 1aimg target dose the error would be 53.33% and at 0.3aimg target dose the error would be 177.77%.

If you had an accuracy of 0.4mg, errors would get divided by 5. So you can possibly weigh down to 1mgai Venlafaxine if you accept an error of 10%. Given the steepness of the receptor occupancy curve at low doses and the sensitivity that most of us experience, I think 10% error is rather risky and you might want to keep the error at least below 5%. This would make weighing possible down to 2mgai target dose (0.4mg acc) and 10.66mgai target dose (2mg acc) respectively.

At least in the case of Venlafaxine I find it hard to imagine to do the "endgame" with a scale unless you are prepared to pay a lot of money for it.

@Musiclover

Would you mind telling us the accuracy of your scale and what it costed?

What weight is shown for a tablet with 2.5mgai Olanzepine?

May 29

@Alfred1977 I think we should move your questions on over to the general thread that talks about scales so we don’t hijack music lover’s thread. You ask some good questions, but I think many of them are answered in that thread (which I don’t have time to look for now). My basic answer to your questions, however, is that you may be overthinking some of this. The bottom line is, if you continue to use the same scale, recalibrate it regularly, measure and weigh the same way throughout your taper, your dosing will be consistent.

May 29

26 minutes ago, FindRest said:

I think we should move your questions on over to the general thread that talks about scales so we don’t hijack music lover’s thread.

Sorry, sure!

May 29

5 hours ago, FindRest said:

The bottom line is, if you continue to use the same scale, recalibrate it regularly, measure and weigh the same way throughout your taper, your dosing will be consistent.

This is my approach in a nutshell. I don't want to get too bogged down in the maths, nor get into over-thinking it. So I'm not going to go into all the ins and outs of my scales or the weighing process. I feel that what I have is probably 'good enough'. Incidentally @Alfred1977, the scales I bought was very reasonably priced but that's not the main reason I bought it. It actually got better reviews on average than the more expensive Gemini and was an 'Amazon Choice' product, for what it's worth. The accuracy is supposed to be +/- 0.001g though it's probably less than that in practice. So for better or worse it is the one I'm working with. And after filing down a few tablets that are now the same weight and look identical (they were the same weight to begin with), I feel quite happy with this setup. The weight of a single tablet was 0.106 grams and I filed down to 0.095 grams, which is 90%.

15 hours ago, FindRest said:

However, you might want to make sure you wait an extra couple of weeks after you think you are fully healed before trying your taper.

I hadn't considered the impact Covid might have on the tapering process. However I seem to be over the worst of it and it was a fairly mild dose anyway, so I feel fine to continue as planned. I've got the energy and the motivation now so I'm going to trust that. I also woke up today feeling excited and with a sense that there is light at the end of the tunnel and also that I am taking back control over my own body, which feels really good. Not that I expect it all to be plain sailing of course!

8 hours ago, Alfred1977 said:

Good luck! 🙂

Thank you! There is a slight cloud over it because I had a conversation with my GP today in which I mentioned my intention to taper off the meds. He wasn't happy and made it clear he doesn't agree. Which is ok, I understand where he is coming from and where most medics come from but I would rather have support from my doctor, if that were possible. I could try and find another GP who would be sympathetic but I think that would be like finding a needle in a haystack here! So I might have to take responsibility for this journey without their support and look for that elsewhere, including here. I'm seeing him next week to discuss the cholesterol issue and to get a few more tests so I may bring him in something to read though being realistic, I doubt he will come on board. He is a nice guy but he can be pretty direct and almost confrontational in his manner, especially on the phone. Methinks he might be a bit 'on the spectrum' as his sensitivity to the nuances of communicating with a patient who tends towards anxiety anyway is not that great!

May 29

3 hours ago, Musiclover said:

The accuracy is supposed to be +/- 0.001g though it's probably less than that in practice. So for better or worse it is the one I'm working with. And after filing down a few tablets that are now the same weight and look identical (they were the same weight to begin with), I feel quite happy with this setup. The weight of a single tablet was 0.106 grams and I filed down to 0.095 grams, which is 90%.

Sorry if I come up with the math again, but I think it is reassuring in your case. If your tablet with 2.5mg Olanzapine weighs 106mg, this would be mgpw/mgai=~40. If your scale has an accuracy of ~1mg you get down to a target dose of 0.5mgai with an error of less that 5% and down to 0.25mgai with an error of less than 10%. So you might be able to use the scale until the very end where you jump off to zero.

May 29

2 hours ago, Alfred1977 said:

Sorry if I come up with the math again, but I think it is reassuring in your case. If your tablet with 2.5mg Olanzapine weighs 106mg, this would be mgpw/mgai=~40. If your scale has an accuracy of ~1mg you get down to a target dose of 0.5mgai with an error of less that 5% and down to 0.25mgai with an error of less than 10%. So you might be able to use the scale until the very end where you jump off to zero.

Ah ok, that's reassuring thanks. It's no problem bringing the maths in if it's relevant to the discussion. I just like to keep things fairly simple, being a bit of a pragmatist!

June 24

I am coming to the end of my first month of tapering and about to do another 10% reduction. I have a question which is probably nit-picking but I'll go ahead anyway.

Do you reduce every month or every 4 weeks? It's not the same thing, with a few days difference each month. That could add up to quite a bit of time in the long run. I started on the 28th of May. If I wait the month that's Friday. If I go with 4 weeks it's tomorrow. I'd appreciate some clarification because I see the two terms used interchangeably in the guidelines.

June 24

3 hours ago, Musiclover said:

I am coming to the end of my first month of tapering and about to do another 10% reduction. I have a question which is probably nit-picking but I'll go ahead anyway.

Do you reduce every month or every 4 weeks? It's not the same thing, with a few days difference each month. That could add up to quite a bit of time in the long run. I started on the 28th of May. If I wait the month that's Friday. If I go with 4 weeks it's tomorrow. I'd appreciate some clarification because I see the two terms used interchangeably in the guidelines.

I often wonder this as well. Probably doesn't make much difference, though. Anywhere from 28-31 days, just do what feels right for you. Brassmonkey is 10% every 6 weeks, a lot of us are doing a lot less than 10% a month so it's not relevant.

June 24

Ok thanks for that. I’ll give it a few more days before reducing.

I have another question about cutting the pills. The 2.5 mg Olanzapine tablets are very small. At this stage I am taking only a small amount off them so I have been using a metal nail file and weighing the tablet after every few passes. This seems to have given me pretty accurate results, according to the scales. However I have read here that using a nail file is not recommended. I have a pill cutter but it only cuts into halves and at this stage I need to make smaller cuts. Would a razor blade be better than the file method? I’d be a bit afraid of cutting too much off whereas I feel I actually have more control with the file.

Musiclover: would really like to find my way off meds but hard to imagine it

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