Stardust: tapering citalopram, bupropion and buspirone

[jutland86]

Hi Stardust - thanks for stopping by on my thread. Thought I would ask how things are going here on your thread?

[Stardust]

@Altostrata Somehow I missed your last post!  I used  Jozeff's Simple Brassmonkey Slide Tapering Spreadsheet for my taper from citalopram 40mg to 20mg.  (20mg was my goal.)  I really had no discernible withdrawal symptoms.  Then again, I never got down to the low doses where things can get hairier.  The taper I did was really easy.

 

As for getting completely off bupropionSR,  100mg is a considerably longer taper and therefore more daunting.

 

Right now I'm six weeks out of surgery for a sarcoma so I'm just starting to think about when to start the bupropion taper.

 

Thanks again for checking in.

[Stardust]

Hi @jutland86 -

 

I've been in a holding pattern in the quest to reduce my medication load.  As I mentioned above I'm currently 6 weeks post surgery to have a sarcoma removed.  I'm feeling a lot stronger and ready to start planning my next taper which will most likely be to get off bupropion completely.

I'm glad for you that your taper has been going so well.

Thanks for stopping by!

 

Stardust

[Altostrata]

Good to hear. FYI Tips for tapering off buproprion (Wellbutrin, SR, XR, XL)

[Stardust]

I met with a new psychopharmacologist yesterday who was highly recommended to me.  I thought maybe I'd find a withdrawal savvy professional to help me get through the bupropion taper and future tapers.  She was easy to talk to and seemed very knowledgeable;  very supportive of my getting off Wellbutrin/bupropion and agreed with my reasoning for getting off.  Then when I asked her about tapering, the party was over: she said in no uncertain terms I should just simply stop taking it.  She saw no benefit in a slow taper and pointed out that adverse reactions to abruptly stopping were very rare.  This stopped me cold and I realized I couldn't work with this person.  Disappointing but not surprising.  

I'll continue with my longtime psychopharmacologist whose limitations I know well and find a way to carry out my taper with SA's guidance and the doctor's cooperation.

[Stardust]

I'm thinking of making initial reductions in buproprion SR using a nail file.  The amount removed is so small, practically a tiny crumb - yesterday I practiced cutting a tablet with a razor blade and it was challenging to remove such a small piece so I thought a file would make better sense at least until I need to remove a larger portion of the tablet. I figured it would leave more of the time release "glue" intact too. I'll be weighing the dose using my GEM scale.

Has anyone else used a file with Wellbutrin / buproprion SR pills?

[Altostrata]

Please add lessons learned here Did I go wrong with my nailfile? Filing or shaving a tablet

[Zim337]

Hi Star,

Im glad your surgery went well. And I think using the microtaper is a smart choice! I checked the numbers, and if you start at 100mg and do the taper 2.5% four weeks and hold 2, you will be at 50mg in 7 months. Half! And in another 7 months youll be down to 25mg. I understand that you would like to go faster, but half the dose already in 7 months isnt bad right?

 

Take care, Zim

[Stardust]

11 hours ago, Zim337 said:

Hi Star,

Im glad your surgery went well. And I think using the microtaper is a smart choice! I checked the numbers, and if you start at 100mg and do the taper 2.5% four weeks and hold 2, you will be at 50mg in 7 months. Half! And in another 7 months youll be down to 25mg. I understand that you would like to go faster, but half the dose already in 7 months isnt bad right?

 

Take care, Zim

 

@Zim337Thanks so much Zim! After many delays over the past couple of years for various reasons, I finally started my bupropion/Wellbutrin taper on Friday morning. I've been nervous about withdrawal symptoms and discouraged about how long it will take. So the timing of your encouraging reply couldn't be better.  The way you frame it, you're right, it doesn't look so bad! 

Thanks again,

Stardust

[Soup]

@Stardust just wanted to wish you luck with your Wellbutrin taper . I to want to start a Wellbutrin taper but still a bit destabilized . 
I look forward to your updates and pray they are all positive and your taper is smooth . 

[Stardust]

Hi Soup,

Thank you for your well wishes!  

I think you're very wise to wait until you feel more stabilized before you start the Wellbutrin taper.  

Take care,

Stardust

[Stardust]

I started my taper of bupropion SR on Friday using the Brassmonkey Slide Method of Micro-tapering.  I'm using the digital GEM scale I used for my citalopram taper.  A big difference between the bupropion SR and citalopram tapers is the way doses need to be prepared.  With  citalopram I could prepare a few weeks worth of doses in advance.  I'd simply crush citalopram tablets into a fine powder using a mortar and pestle, weigh the powder for the correct dosage and fill capsules.  I marked sandwich bags with the dose for each particular week.  In contrast, bupropion SR loses its sustained release properties if you crush it or cut into small pieces because bupropion is hydrophilic, meaning its time-release binder can absorb humidity and degrade, so if you break up a tablet for doses it must be used within 24 hours. When that happens you lose the time release and end up essentially taking Immediate Release.  I'd like to avoid that for as long as possible because I figure  it will be easier on my system the longer I have the benefit of any remaining sustained release properties. This means I have to prepare the dose each day.  It's less of a big deal than it sounds - I'm not wearing a lab coat and goggles and handling beakers and flasks!  I tried cutting the tablets but I found it so imprecise I decided to use a nail file.  I got one of the higher rated nail files on Amazon which supposedly has abrasion made from sapphire - after filing 4 pills over 4 days the abrasion was worn off.  So I went to Home Depot this morning and bought a metal file which I'm hoping will be an improvement.  What I've been doing is filing off a bit at a time and weighing the tablet until it's at the target dosage for this week.  The whole thing takes just a couple of minutes.  I'll report back about how the new file works.

[Soup]

@Stardust I am wondering when you file off the SR tablet does it not turn into immediate release or is the time release inside of the pill ? Part of the powder ? Just wondering ? 
Thanks 

Hope this goes well for you 

[Stardust]

Soup -

Bear in mind, I'm not an expert.  My understanding is that with SR the sustained release quality is in the binder, the glue that holds the tablet together and that if you divide a pill, as long as you aren't crushing it or cutting it into tiny pieces, it retains it sustained release characteristic. On the other hand, if you cut up XL or XR, it does become immediate release.

Stardust

[Altostrata]

On 9/19/2022 at 9:58 AM, Stardust said:

In contrast, bupropion SR loses its sustained release properties if you crush it or cut into small pieces because bupropion is hydrophilic, meaning its time-release binder can absorb humidity and degrade, so if you break up a tablet for doses it must be used within 24 hours.

 

If you put the fragments into a gel cap immediately (and take the capsule within a few days), they will not absorb moisture.

 

On 9/19/2022 at 2:47 PM, Stardust said:

My understanding is that with SR the sustained release quality is in the binder, the glue that holds the tablet together and that if you divide a pill, as long as you aren't crushing it or cutting it into tiny pieces, it retains it sustained release characteristic. On the other hand, if you cut up XL or XR, it does become immediate release.

 

All the bupropion types become immediate-release if they are cut up, as the binder is breached. The larger pieces might retain some SR or XR characteristic, but you cannot know how long they'll release the drug. 

 

On 9/2/2022 at 2:30 PM, Altostrata said:

Please add lessons learned here Did I go wrong with my nailfile? Filing or shaving a tablet

 

[Stardust]

@Altostrata Thank you for correcting my misunderstanding.    

 

This is the first week of my taper off 100mg SR.  I've been filing 2.5% off the pill and taking it in the morning.  Since cutting into the pills  is essentially  making them IR that means I'm getting flooded with 100mg all at once.  This concerns me because my primary issue is terrible anxiety.  I'm already experiencing unpleasant cortisol surges.  Does it make more sense for me to divide the dose, taking one dose in the a.m. and one in the mid afternoon? Or even divide it into three doses? I'll do whatever I need to do to make this a less bumpy ride.

 

Thanks very much,

Stardust

 

[Altostrata]

If you regularly get a surge of "anxiety" shortly after taking Wellbutrin, you may wish to divide the dose.

[Stardust]

I started my taper off bupropion SR - it did not go well.  I had tapered 2.5% (doing a micro taper) by filing the buproprion SR pills.  After a few days I started experiencing terrible surges of anxiety at several points during the day.  I decided to return to original dose and wait to stabilize.  My next plan is to ask my psychopharmacologist to prescribe bupropion IR 100mg, transition to that, probably cut into two doses a day (one in a.m and the second around 4pm) to approximate the "sustained release" my system is used to. I could use some help planning this out.  Not sure, for example, what time of day to take in afternoon.

Thanks,

Stardust

[Altostrata]

You may wish to take half at 8 a.m. and half at 4 p.m. You may experience a few bumps as you make this transition, and have to adjust the dosing schedule.

[Stardust]

Thank you

[j1290]

Hi @Stardust!   I heard there was another person tapering Bupropion, so I looked around to see if I could pick up any tips.   The different time releases and manufacturers sure makes it an adventure, doesn't it?!   It took me a lot of experimenting to find a path that for me seems to lead to the bottom of this mountain.   Hang in there, you'll find yours!!!

[Soup]

@Stardust I believe Wellbutrin ( bupropion ) has been highly underrated as to how difficult it can be to taper off the types they dole out . Mine is xl and no other options in my country . It is certainly a lot trickier than I ever thought that’s for sure . Hope we can all find a road out of this .Best of luck 

[Stardust]

@j1290 So glad you stopped by and introduce yourself!  I've been feeling kind of alone in the wilderness frankly.  At times I feel very discouraged about what it's going to take to get through tapering off bupropion. After the hell I went through after I quit benzos I dread going through anything like it again.  At other times I feel stronger and confident I can take it on.  

At this point I'm planning to wait (yet again) until after Thanksgiving with family before I start the taper.  My first step will be to switch to IR and wait until I stabilize from the switch before I start the actual taper.  I'm crossing my fingers that my psychopharmacologist will be supportive of my plan and prescribe IR.

I read through your Intro thread.  Looks like you've been through an awful lot and I'm sorry, but now it looks like you're seeing a clearer path forward.  

I'm really glad to be in contact with a fellow traveler.

Stardust

[Stardust]

@Soup  Have you started your Wellbutrin taper - I can't tell from your signature.

[Soup]

@Stardust no I have not started my taper I had  been hoping to stabilize  but do not seem to be able to get any better . Everybody here says I need to stabilize more to start again . I am scared to start but also afraid I am so sick still because of the Wellbutrin ( although I was a lot  better last year before the antibiotics ) it seems a monumental mountain to climb right now and not sure if I have it in me ( although I want nothing more than to be off this poison ) I hope we can both find our ways out of this with the least amount of pain 

[j1290]

@Stardust Sounds like you have a great plan to move forward, and congrats on getting off the benzos!!  I can't even imagine what commitment that took.   Haha yeah I went down a lot of dead ends before winding up where I am now, but I'm hopeful that I'm moving in the right direction.   Sounds like you are too!

[Stardust]

Thanks @j1290 (Just saw this) 

 

[Stardust]

Looking for suggestions on how to talk to my psychopharmacology doc about switching from SR to IR - I hope to switch over so I can taper off IR.  Does anyone have any tips for how to approach making this request? She was completely dismissive when I complained of horrible withdrawal symptoms after she tapered me too fast off Klonopin a few years ago, saying it was the return to my baseline.  Since then I haven't completely trusted her although I know she means well.  I just want to present my case matter of factly.  I have an online appointment with my her on 11/30.  

[ChessieCat]

how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect

 

You might find it helpful to write a script of some sort with points about what you want and how you might respond if she answers a particular way.  Remember that any doctor can prescribe.

 

It's important to remain calm, polite and assertive without being aggressive because you don't want to come across as being a know it all (but in this area you may know more than the doctor).  Use terms like I would like to try this, instead of I want to do it this way.  Listen to what they have to say and reply with something thank you for explaining that or I understand that you think such and such but I have done some research and I think this might be a better way to do it and I would like to try this way first.  These are just suggested ways of wording.  Another, I have experienced withdrawal before when trying to reduce and I believe that doing it more slowly will help me to lower my dose (sometimes doctors are more amenable if they think you are staying on a small dose of the drug - you can use the term I would like to be on the lowest effective dose)/get off without withdrawal symptoms.  I can remember saying to my doctor that I realise that many other people might be able to get of their drug quickly but I would prefer to go slowly.  (He actually shook his head and quietly said "not many" - he knew I was tapering using information from SA and was happy to write my scripts - I was very fortunate.  Six year later I was able to tell him that I had got off successfully and he was surprised at how long I had taken to do it.  However, if he hadn't been happy about me tapering I probably would have gone to a different doctor.)

 

Remember that you are the one that is going to be affected by whatever method you use, not the doctor.  We need to advocate for ourselves.

 

Good luck.  Let us know how it goes.

 

 

[j1290]

FWIW I have very mixed feelings about my treatment overall, however when I asked if the IR was easier to divide due to how it was distributed in the tablet for a slow taper, I was able to get the script.   Good luck!!

[Stardust]

On 11/18/2022 at 10:57 PM, ChessieCat said:

how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect

 

You might find it helpful to write a script of some sort with points about what you want and how you might respond if she answers a particular way.  Remember that any doctor can prescribe.

 

It's important to remain calm, polite and assertive without being aggressive because you don't want to come across as being a know it all (but in this area you may know more than the doctor).  Use terms like I would like to try this, instead of I want to do it this way.  Listen to what they have to say and reply with something thank you for explaining that or I understand that you think such and such but I have done some research and I think this might be a better way to do it and I would like to try this way first.  These are just suggested ways of wording.  Another, I have experienced withdrawal before when trying to reduce and I believe that doing it more slowly will help me to lower my dose (sometimes doctors are more amenable if they think you are staying on a small dose of the drug - you can use the term I would like to be on the lowest effective dose)/get off without withdrawal symptoms.  I can remember saying to my doctor that I realise that many other people might be able to get of their drug quickly but I would prefer to go slowly.  (He actually shook his head and quietly said "not many" - he knew I was tapering using information from SA and was happy to write my scripts - I was very fortunate.  Six year later I was able to tell him that I had got off successfully and he was surprised at how long I had taken to do it.  However, if he hadn't been happy about me tapering I probably would have gone to a different doctor.)

 

Remember that you are the one that is going to be affected by whatever method you use, not the doctor.  We need to advocate for ourselves.

 

Good luck.  Let us know how it goes.

 

 

Chessie-

Thank you so much for all your thoughtful guidance.  I truly appreciate it.  I'll report back how it goes.

Stardust

[Stardust]

On 11/18/2022 at 11:03 PM, j1290 said:

FWIW I have very mixed feelings about my treatment overall, however when I asked if the IR was easier to divide due to how it was distributed in the tablet for a slow taper, I was able to get the script.   Good luck!!

j1290- 

Thanks very much - good to know!  

Take care,

Stardust

[Stardust]

I had an appointment with my pdoc yesterday.  Told her I want to taper off Bupropion/Wellbutrin SR 100 mg and that I want to switch to IR for the taper.  Asked her to prescribe IR  and explained why. She doesn't understand the concept of slow tapering and pushed back but I stood firm and she ultimately agreed to prescribe the IR 100mg.    

 

The suggestions ChessieCat gave me were really helpful - I practiced what I wanted to say before the session.  It really went well and I got the outcome I wanted.  I wish the pdoc was more knowledgeable about tapering so we could fully collaborate on this but so it goes.

 

I should get my new pills in the mail next week.  I plan to take the IR 100mg for a few weeks to get used to it before starting the taper.  Still on the fence about whether to split the dose.  If anyone has any thoughts about thisI'd appreciate hearing from you.

[j1290]

Congrats, Stardust!   

 

I can share a little experience with Bupropion.  For me, switching from 450mg XL to IR I got significant symptoms for about a week.  There's a Bupropion chart somewhere that shows absorption levels on the different time releases.   I'm doing 3 doses a day, 6 hours apart, but I'm still at a much higher level 327mg. 

 

I've found the symptoms of IR to be stronger than the XL I used to take, but a little less mood elevation.  

 

I switched 10% of my daily total to liquid, and found it caused no reactions or differences at all, actually.   I will tackle it when I get there, but my initial thought when I get below 112mg I may just switch to all liquid so it's easier to manage 3 doses per day.   

 

That's awesome you got 100mg pills, I'm not great with numbers so at some point I may ask for those myself for easier measuring of liquid solutions.   

 

Please keep us posted with your updates, and congratulations again!

[Zim337]

What a relief, congrats and well done!! 💪

Staying on the same dosage while adjusting to IR sounds like a good idea. As you know I dont take buproprion, but I take buspar 7 am and 7 pm (they are IR). For buspar it’s recommended to split the dosage in two or three.

 

Take care,

Zim

 

 

[Stardust]

Thanks so much j1290!

 

I've been vacillating about whether to split the dose but I think I will split it in two dose, 6 or 8 hours apart.  

Once I switch to the Immediate Release I'll give myself a month or two to adjust to the new formulation before I start the taper.

 

12 hours ago, j1290 said:

I've found the symptoms of IR to be stronger than the XL I used to take, but a little less mood elevation.  

 

What symptoms did you get with the IR?

12 hours ago, j1290 said:

I will tackle it when I get there, but my initial thought when I get below 112mg I may just switch to all liquid so it's easier to manage 3 doses per day.   

Interesting - I'll keep this idea in mind too.