Zans: tapering off 10mg Brintellix - 4 years?

[Zans]

Hey,

 

been having some ok moments last days but my sleep follows weird rhytm. I can sleep 7h one day and next two I sleep about 1-2h each. That's still rough but it could be early coffee I am trying to reintroduce.

 

Appearantly scales is in 1mg jump so I think liquid is the way to go? My next dose suppose to be 4.5mg. Do I mix 10mg tablet in 10ml water and take 4.5ml with syringe of it as my dose? 

 

Apologies, it's really confusing for already confused brains ☺

[ChessieCat]

See this topic for discussion of weighing doses using a scale: using-a-digital-scale-to-measure-doses

 

BrassMonkey managed to get down to very low doses using the Gemini 20 scale.  BrassMonkey's success story. 

 

When changing form of a drug we suggest doing a cross over which is gentler on the nervous system.  Only make one change at a time, so do not make a reduction at the same time as doing the cross over.   Keep it Simple, Slow and Stable . 

 

Do each combination for about 3 to 7 days:  3/4 + 1/4, 1/2 + 1/2, 1/4 + 3/4.

 

It is also a good idea to keep daily symptom notes on paper and if symptoms worsens stay on that combination for a bit longer.

 

It is also a good idea to keep daily symptoms notes for at least a few days after you have completed the cross over.

[Zans]

16 hours ago, ChessieCat said:

See this topic for discussion of weighing doses using a scale: using-a-digital-scale-to-measure-doses

 

BrassMonkey managed to get down to very low doses using the Gemini 20 scale.  BrassMonkey's success story. 

 

When changing form of a drug we suggest doing a cross over which is gentler on the nervous system.  Only make one change at a time, so do not make a reduction at the same time as doing the cross over.   Keep it Simple, Slow and Stable . 

 

Do each combination for about 3 to 7 days:  3/4 + 1/4, 1/2 + 1/2, 1/4 + 3/4.

 

It is also a good idea to keep daily symptom notes on paper and if symptoms worsens stay on that combination for a bit longer.

 

It is also a good idea to keep daily symptoms notes for at least a few days after you have completed the cross over.

1) Hey Cheese, thanks for response. Can you explain what those numbers mean 3/4 + 1/4, 1/2 + 1/2, 1/4 + 3/4?

 

2) Can you confirm if my calculations are right? If my dose 4.5mg I would dissolve 10mg pill into 10ml water, then would take 4.5ml with synarge. Is that correct? Am I not missing something?

 

Thank you

[ChessieCat]

5 hours ago, Zans said:

Can you explain what those numbers mean 3/4 + 1/4, 1/2 + 1/2, 1/4 + 3/4?

 

3/4 of the dose as tablet + 1/4 dose as liquid etc

[ChessieCat]

5 hours ago, Zans said:

If my dose 4.5mg I would dissolve 10mg pill into 10ml water, then would take 4.5ml with synarge. Is that correct?

 

Yes that is correct.  You can keep the other portion in a covered container in the fridge and use for your second dose.  Discard the left over.

 

Remember to do everything the same way each time, same equipment, same area of bench/table for measuring, same method of measuring your dose.

[Zans]

11 hours ago, ChessieCat said:

 

Yes that is correct.  You can keep the other portion in a covered container in the fridge and use for your second dose.  Discard the left over.

 

Remember to do everything the same way each time, same equipment, same area of bench/table for measuring, same method of measuring your dose.

Thanks,

 

is it fine to use one synarge multiple times? I assume if I'd be shooting heroin and sharing needles that would be somewhat of a concern but preparing batch is different I guess?

[ChessieCat]

Yes you can re-use the syringe.

[Zans]

Hey,

 

not doing terrible lately. My sleep is improving and on a lucky day I get 8h +. Started to drink cacao, hang out with friends and spend a lot of time in sun.

 

Next month I'll jump from 5 to 4.5mg. I currently dissolve 10mg pill in 10ml water. With 5mg I take in currently it's easy to finish 10mg liquid in two days however with 4.5mg I'll have 1mg left after two days. How ling can I keep it in the fridge? Ideally I'd combine 1mg leftovers until I'd have 4.5mg again but not sure on how long I can keep liquid in a fridge?

 

Thanks!

[ChessieCat]

You can keep it in a dark covered container in the fridge for 3 days so you can get 4 doses out of one batch of liquid.

 

Day 1 will be the day you make the liquid.  Day 4 dose will be at the end of 3 x 24 hour periods after making the liquid.

 

Edited August 27, 2019 by ChessieCat
change info

[Zans]

On Tuesday, August 27, 2019 at 3:22 AM, ChessieCat said:

You can keep it in a dark covered container in the fridge for 3 days so you can get 4 doses out of one batch of liquid.

 

Day 1 will be the day you make the liquid.  Day 4 dose will be at the end of 3 x 24 hour periods after making the liquid.

 

Hey,

 

apologies for slow mental digestion process. I don't undetstand how can I get 4 doses out of one batch. If I mix 10mg into 10ml then yes but next month my dose going to be 4.5mg instead of 5mg so out of 10ml batch I have additional 1mg left (2 days of 4.5mg). So assuming I can only keep "leftovers" for 3 days that means expiration date on that 1mg is too short to stock it up for upcoming doses. I guess I just get rid of it?

 

Thanks

[ChessieCat]

My apologies.  I started off the post saying that you could use 2 x 10mg tablets in 20mL water and you would get 4 doses from that.  Then I realised that it was no different from using 10mg tablet in 10mL for 2 doses.

 

I then decided to leave in the information about how long you could keep the liquid but didn't respond about the dosing.

 

Yes you are correct.  At the moment you won't have enough remaining and will need to discard the left over amount which will be 1mg dose over a 2 day period.

 

The following reduction will be 4.5mg x 0.9 = 4.05mg.  It won't be until you get to 3.645mg, or 3.65mg if you round up, that you would be able to get 5 doses our of 20mg tablet in 20mL of water.

 

I hope that makes sense.

 

The other option would be to either crush your tablets and divide up or weigh them or to cut a tablet in half, but you need to take into consider how accurate these ways would be.

[Zans]

2 hours ago, ChessieCat said:

My apologies.  I started off the post saying that you could use 2 x 10mg tablets in 20mL water and you would get 4 doses from that.  Then I realised that it was no different from using 10mg tablet in 10mL for 2 doses.

 

I then decided to leave in the information about how long you could keep the liquid but didn't respond about the dosing.

 

Yes you are correct.  At the moment you won't have enough remaining and will need to discard the left over amount which will be 1mg dose over a 2 day period.

 

The following reduction will be 4.5mg x 0.9 = 4.05mg.  It won't be until you get to 3.645mg, or 3.65mg if you round up, that you would be able to get 5 doses our of 20mg tablet in 20mL of water.

 

I hope that makes sense.

 

The other option would be to either crush your tablets and divide up or weigh them or to cut a tablet in half, but you need to take into consider how accurate these ways would be.

No problem!

 

Yeah, unfortunately I'll have to spill it out then. God damn this whole process is lighting cash on fire. 

 

I have another question if you don't mind. Do you know if it's common for depression to be more severe after SSRI (even with gradual taper) or actually during usage? Perhaps website have something to read about it? 

 

Thanks

[ChessieCat]

Yes, it's frustrating that it wastes money.  I'm having to pay to have my Pristiq tablets compounded into capsules.

 

But think of it this way.  If you were still on the tablets it would be costing you the same amount of money.  And the benefit, even though it is costing you money now, you are not only reducing the drug you take so it is better for you, but in the long run you won't be buying the tablets at all so will save money.

 

Regarding you question, I will check with the other mods.

[Altostrata]

On 8/30/2019 at 3:52 AM, Zans said:

Do you know if it's common for depression to be more severe after SSRI (even with gradual taper) or actually during usage? Perhaps website have something to read about it? 

 

What do you mean, Zans? Are you having this symptom?

[Zans]

7 hours ago, Altostrata said:

 

What do you mean, Zans? Are you having this symptom?

Yeah, I have days where sadness is quite painfull if that makes sense and I also feel really flat at best. No joy, no enjoyment. 

[Altostrata]

Which days are those? What are you thinking about when this happens?

[Zans]

12 hours ago, Altostrata said:

Which days are those? What are you thinking about when this happens?

It hits me randomly. I used to think it's permanent and that once I'll be off pill this going to be my default mode how I feel. But I try to ruminate less now as I had some ok moments which shows that happy state is not fully gone from me.

[Zans]

So after being on 5mg full August I made cut to 4.5mg on September 1st. Since then can't sleep again and feeling overexcited. In three days I slept maybe 8 hours total. Was doing ok sleep wise prior cut. Is this expected after cut?

[ChessieCat]

Quote

 

Finlepsin 1/4, Olanzapine 2.5mg, Relanium 5mg, Brintellix 20mg, Imovan mid April - early May 2019. CT all.

 

Brintellix 10mg 2019 May

Brintellix 5mg June - July

Brintellix 2.5mg since 10th July, reinstated back to 5mg July 15.

 

 

Please update your drug signature:  Account Settings – Create or Edit a signature

 

Early May you cold turkeyed all your drugs.

 

Since then you have reinstated Brintellix and changed doses 10mg, 5mg, 2.5mg, 5mg, 4.5mg. 

 

You have made a lot of changes in a short period of time.  It could by any one of those or a combination that have caused the issues.

 

It takes about 4 days for a dose change to get to full level in the blood and a bit longer for it to register in the brain.

 

You have several options:  

• return to 5mg Brintellix

• updose by a small amount, perhaps to 4.75mg Brintellix

• hold on 4.5mg Brintellix

[Zans]

6 hours ago, ChessieCat said:

 

Please update your drug signature:  Account Settings – Create or Edit a signature

 

Early May you cold turkeyed all your drugs.

 

Since then you have reinstated Brintellix and changed doses 10mg, 5mg, 2.5mg, 5mg, 4.5mg. 

 

You have made a lot of changes in a short period of time.  It could by any one of those or a combination that have caused the issues.

 

It takes about 4 days for a dose change to get to full level in the blood and a bit longer for it to register in the brain.

 

You have several options:  

• return to 5mg Brintellix

• updose by a small amount, perhaps to 4.75mg Brintellix

• hold on 4.5mg Brintellix

I eventually fall asleep, fortunately. What is rationale to comeback to same dose as last month and if I would reinstate back to same amount does it mean I have to stay on it full month again? That way tapper would take ages it seems.

[ChessieCat]

I was stating what options you have.

 

 

 

[Zans]

39 minutes ago, ChessieCat said:

I was stating what options you have.

 

 

 

Ah ok ☺ Is there time window after which if things are still rough reinstating becomes better option? I mean how much enduring it's healthy to experience? I would guess week and a half or something close to that?

[ChessieCat]

According to this topic About reinstating and stabilizing to reduce withdrawal symptoms which it is better to reinstate as soon as the withdrawal symptoms appear.

 

So if your symptoms are unbearable it would be better to updose sooner, rather than later.  The question I ask myself is, if this continues can I live with it?  There have been a couple of times when I have answered no and updosed a small amount.  There have been other times when I have felt that I could handle the symptoms so I didn't updose.

 

It takes about 4 days for a dose change to get to full level in the blood and about a week for it to register in the brain.

 

Because it is your sleep which has been affected if it was me I'd be making a small updose immediately.  You could try going to 4.6mg and see if that helps with your sleep.

[Zans]

33 minutes ago, ChessieCat said:

According to this topic About reinstating and stabilizing to reduce withdrawal symptoms which it is better to reinstate as soon as the withdrawal symptoms appear.

 

So if your symptoms are unbearable it would be better to updose sooner, rather than later.  The question I ask myself is, if this continues can I live with it?  There have been a couple of times when I have answered no and updosed a small amount.  There have been other times when I have felt that I could handle the symptoms so I didn't updose.

 

It takes about 4 days for a dose change to get to full level in the blood and about a week for it to register in the brain.

 

Because it is your sleep which has been affected if it was me I'd be making a small updose immediately.  You could try going to 4.6mg and see if that helps with your sleep.

Thank you Chessie, you've been really helpful so far!

[ChessieCat]

Please be patient.  Don't panic.  When we panic we can make bad decisions.  We have had members who panicked and ended up increasing their dose by too much and made things worse.

 

Nice and slowly.

 

Keep daily notes on paper so you can see how the updose affects your symptoms.  And please note that you aren't trying to get rid of the symptoms completely but to bring them to a bearable level.

 

And remember to only make one change at a time.  If you change 2 things and your symptoms change (for worse or better) you won't know what has caused it.

 

Please read Post #1 of this topic:  Keep it Simple, Slow and Stable

[Zans]

I am having hard time. Three days ago I had nice 8h sleep. It's been third night without a sleep. Lots of anger showed up out of blue as well. Feelings of being on the edge.

 

Should I reinstate back to 5mg?

 

If I do so how long I stay there before trying to cut again?

 

Thanks. 

[ChessieCat]

On 9/4/2019 at 6:31 PM, ChessieCat said:

You could try going to 4.6mg

 

[Zans]

5 hours ago, ChessieCat said:

 

Will try that and update whether it had any change. So far symptoms are from category "I could not live with if it'd petsist".

 

Thank you

[Zans]

I literally can't relax now. Feeling so amped up and it looks like It's going to be 5th night without sleep. Man I am so afraid because this exact scenario of massive sleep deprivation and anxiety what landed me to hospital first time. Feels like damn deja vu.

 

Should I reinstate back to 5mg or wait longer?

[ChessieCat]

I've already mentioned a couple of times that if you updose it is better to increase by a small amount.

[Zans]

6 hours ago, ChessieCat said:

I've already mentioned a couple of times that if you updose it is better to increase by a small amount.

Would you say it'd be wise now to up to 4.7mg? I am really afraid of this stretch of no sleep accumulating again.

[ChessieCat]

The longer you have been at the lower dose the smaller the updose, not higher, because your brain will have already made some adaptation to being on the 4.5mg.

[Zans]

25 minutes ago, ChessieCat said:

The longer you have been at the lower dose the smaller the updose, not higher, because your brain will have already made some adaptation to being on the 4.5mg.

Seems you're available 24/7 😀 Thanks for quick replies. Ok so I've been week on 4.5mg and since yesterday on 4.6mg. Things not getting any better so I guess wait another several days before updosing to 4.7mg? 

[ChessieCat]

On 9/4/2019 at 10:34 AM, ChessieCat said:

It takes about 4 days for a dose change to get to full level in the blood and a bit longer for it to register in the brain.

 

[Zans]

On Monday, September 09, 2019 at 8:57 AM, ChessieCat said:

 

I feel better and was able to sleep last night without being unable to stay in one position for more then 5 minutes. Thanks Chessie, you've been safe harbor during recent stormy days.

 

Even though I dropped dose from September 1st it's only now, on 11th, where I feel stable again. Given that:

 

1) Is it wise to cut next dose on October 11th or I still can try to cut on October 1st?

 

2) My next dose going to be 4.1mg. If I'll get disastrous outcome I should try 4.2mg reinstatement once 4+ days passes?

 

3) How you've been doing? ☺

 

Thank you

[ChessieCat]

On 9/4/2019 at 10:34 AM, ChessieCat said:

 

Early May you cold turkeyed all your drugs.

 

Since then you have reinstated Brintellix and changed doses 10mg, 5mg, 2.5mg, 5mg, 4.5mg. 

 

You have made a lot of changes in a short period of time.  It could by any one of those or a combination that have caused the issues.

 

 

I think it's time to have a nice long hold, at least 2 months, 3 would be better.  You have made many changes in the last 4 months, see ^ quote.  Give your brain the time it needs and get nice and stable.  If you keep reducing you might make things much worse.  Withdrawal can be delayed and/or the dose changes can catch up with you.  When this happens it is sometimes hard to stabilise and/or can take a long time, and some members never stabilise and have to taper anyway.

 

9 hours ago, Zans said:

My next dose going to be 4.1mg. If I'll get disastrous outcome I should try 4.2mg reinstatement once 4+ days passes?

 

No, this is not the way to taper.  Jumping up and down, aka yo-yoing, your doses can backfire on you.  And we have members here who have done this and it has ended up taking longer to get off their drug than if they done a nice steady taper.

 

Many members find that as their dose gets lower they need to go slower, reducing less and/or holding longer  Why taper paper: dose-occupancy curves

 

And you don't have to reduce by 10%.  You can always reduce by a smaller amount.  The rate you taper at should be what you can reduce by that doesn't cause bad withdrawal symptoms.

 

The harm reduction method of tapering means that we take away a little bit of the drug and then stay on that dose to allow the brain to adapt to not getting as much of the drug.  Then we can take away a little bit more and so on.