Deean: question about tapering

[Deean]

Hi there.  So very glad to have found this site.  Such a relief to see well-meaning and intelligent information around this topic.

My query is around tapering. 

I just finished tapering off of 'half' my total dose of Escitalopram.  I did it over approximately an 11 month period (would need to verify that amount as I think it may have been more) by eliminating a certain percentage of a tablet starting 1 day/week.  All the other 6 days, I took the prescribed amount.  (FYI, my family doctor was aware and supportive of my plan.)

I followed that regime for at least a month at a time or until any residual withdrawal symptoms appeared to be over.  Then, I moved to 2 days/week and so forth.  Is this type of taper method unsafe?

I ask because I still have half my original dosage to taper off of in the future.  However, I am pausing that medication to work on tapering another - Vyvanse. 

Of course, it being a stimulant, I want to be extra careful.  I am currently using capsule form and started tapering 2 days ago - taking only 1 of the 2 capsules I would normally take in a day. 

I am on low doses of each of the meds I am on.  (currently 3 different types - anti-anxiety, stimulant and mood stabilizer)

Two days ago was day 1 of tapering the Vyvanse, with the idea to use same method as with the Escitalopram.  However, I started to wonder if this was actually a good idea.  I went on to the internet and after reading the article: "What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications", I thought it important to reach out and ask. 

Thank you so much in advance for providing this forum to discuss.

I look forward to hearing people's thoughts on this.

Deean

[Frogie]

@Deean

 

Welcome to SA. We are a volunteer ran site helping people taper off psychiatric medications or have tapered off and are now healing.

 

This is your introduction page where you will receive information, ask questions and meet other members. We ask that you only have one introduction page so we can keep all your information in one place.

 

First can you please create a signature.

 

How to List Drug History in Signature

 

 

I'm going to give you some links to read that you will find helpful:

 

Why taper by 10% of my dosage?

Taking multiple psych drugs? Which drug to taper first?

 

NEVER SKIP DOSES TO TAPER

Tips for tapering off escitalopram (Lexapro)

 

Tips for tapering off Vyvanse(lisdexamfetamine dymesylate

 

Stabilising After a Reduction - What Does That Mean?

Withdrawal Normal Description

 

 Waves and Windows in SSRI Withdrawal

Dr. Joseph Glenmullen's withdrawal symptom checklist

How do you talk to a doctor about tapering and withdrawal?

 

 

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications:

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

 

 

Because you are tapering the Escitalopram I would not stop that to taper the Vyvanse. You do not want to taper 2 drugs at the same time. It took me 5 years to taper off 10 mg Escitalopram. You stated you are taking 3 medications, what is the other?

 

 

We don't suggest supplements on here except 2 because they can be very stimulating to the central nervous system (CNS). If you would like to try one try a small amount and wait a few days before introducing the other.

 

 

Magnesium

Omega 3 Fish Oil

 

 

After you have read the links provided please reach out with any questions you may have.

 

 

[Deean]

Thanks so much for all this Frogie.

I will continue to read and gather information necessary to my taper journey.

One thing about your suggestion to not stop the Escitilopram to taper the Vyvanse...I want to get off the Vyvanse because of it's stimulant and appetite suppressent factors.  These are affecting me the most.

 

You also have me concerned about Supplements - would you have any recommended reading on that?  

 

Thanks very much

[Deean]

Hi again, updated my signature which I thought I'd sent with last post.

 

 

[ChessieCat]

10 minutes ago, Deean said:

You also have me concerned about Supplements - would you have any recommended reading on that?  

 

There are many existing topics on SA including various supplements.  You can search for individual ingredients using the site search function or use a search engine and add site:survivingantidepressants.org to the search term.

 

[Deean]

 

On 8/20/2022 at 11:12 AM, ChessieCat said:

 

There are many existing topics on SA including various supplements.  You can search for individual ingredients using the site search function or use a search engine and add site:survivingantidepressants.org to the search term.

 

Thanks very much ChessieCat

Edited August 21, 2022 by ChessieCat
removed duplicate quote

[Deean]

Hi again ChessieCat,

 

It's been a while since I posted and just wanted to let you know that I have decided to pause on the tapering for a little bit to let things settle and figure out my next course of action in regards to tapering.

I will continue to read the links you provided me with and go from there.

When I am decided on next plans, shall likely see you here.  (if you are still on the site)

 

Thanks so much for all your help thus far.

Kind regards,

Deean

[Faure]

Hi, I am not a mod, but if I understand correctly you are basically skipping days to taper. 10mg one day and 20mg on the other 6, then I assume after a week or so it would be 10 mg on 2 days and 20 on the others. This is skipping days.  I did this with mirtazepine and became extremely destabilised. It is a really bad idea to do this because the levels of drug are fluctuating in your brain and end up causing instability and probably causing a crash. It took me months to recover; during the first 4 I couldn’t work at all and for the next 18 months only very part time. Never mind a social life, seeing friends, going out and so on. I still am not living as I did pre mirtazepine and I’m conducting the BrassMonkey slide (on my 4th attempt off this drug).  Things get better all the time but very very slowly but fortunately very steadily. 
 

The safest way to taper is the 10% method or the BrassMonkey slide which takes things even slower. I was resistant to this because I wasn’t interested in grinding up pills and weighing and so on, but it soon because very easy and now I make up a week at a time and it takes no more than 15 minutes. 
 

Please do read the info ChessieCat has given you and choose a taper method recommended here. We see people constantly on here (often extremely unwell) because doctors have told them to skip days / cut doses in half at once / denied withdrawal effects and so on. When things go wrong nothing can make the better, no pills, no doctors, just a lot of time during which people often feel absolutely awful. If you have got this far and are ok you’re lucky, but don’t assume that luck will hold. Taking a long hold now will allow your brain to adjust, so that is a good idea if that’s what you’re doing. 
 

Do let us know how you are doing and ask any questions you may have ☺️

[Deean]

21 hours ago, Faure said:

Hi, I am not a mod, but if I understand correctly you are basically skipping days to taper. 10mg one day and 20mg on the other 6, then I assume after a week or so it would be 10 mg on 2 days and 20 on the others. This is skipping days.  I did this with mirtazepine and became extremely destabilised. It is a really bad idea to do this because the levels of drug are fluctuating in your brain and end up causing instability and probably causing a crash. It took me months to recover; during the first 4 I couldn’t work at all and for the next 18 months only very part time. Never mind a social life, seeing friends, going out and so on. I still am not living as I did pre mirtazepine and I’m conducting the BrassMonkey slide (on my 4th attempt off this drug).  Things get better all the time but very very slowly but fortunately very steadily. 
 

The safest way to taper is the 10% method or the BrassMonkey slide which takes things even slower. I was resistant to this because I wasn’t interested in grinding up pills and weighing and so on, but it soon because very easy and now I make up a week at a time and it takes no more than 15 minutes. 
 

Please do read the info ChessieCat has given you and choose a taper method recommended here. We see people constantly on here (often extremely unwell) because doctors have told them to skip days / cut doses in half at once / denied withdrawal effects and so on. When things go wrong nothing can make the better, no pills, no doctors, just a lot of time during which people often feel absolutely awful. If you have got this far and are ok you’re lucky, but don’t assume that luck will hold. Taking a long hold now will allow your brain to adjust, so that is a good idea if that’s what you’re doing. 
 

Do let us know how you are doing and ask any questions you may have ☺️

Hi Faure,

 

Really appreciate your post and all the information and experiences you have shared.

The more I read on the tapering topic, the more I see the importance of the slow taper forsure!

 

You were very close on what my plan had been to taper, however, I was only going to reduce to 10mg, 1x / week for an entire month.  Then wait until I felt stablized and then go to 2x / week and so on.   

However, I now realise that is not a smart idea either.

So, I am in the midst of researching the 10% taper and how to go about it before I take any next steps.

I am tapering from capsules, so I want to really understand the whole liquifying process and measuring/math, etc.

 

Again, really nice of you to message me and offer your thoughts.

Kind regards,

Deean

[Faure]

1 hour ago, Deean said:

You were very close on what my plan had been to taper, however, I was only going to reduce to 10mg, 1x / week for an entire month.  Then wait until I felt stablized and then go to 2x / week and so on.   

However, I now realise that is not a smart idea either.

So, I am in the midst of researching the 10% taper and how to go about it before I take any next steps.

👍

[Timberline]

Hi @Deean. Very wise of you to reach out here! ChessieCat has provided the best info for you to look over. One thing I can add from experience is that the lower you get, the slower you should go. So, lets be thankful that your previous method got you this far, but a change in course would be best! I've been tapering lexapro since June of 2020 and am .5mg from 10mg. The only time I ran into issues was when I got under the 1mg mark and decided to speed up the taper because I was so close to the finish line! Boy, what a bad idea. I am so thankful I got past that speed bump and can now continue to taper. If you're able to get your hands on the liquid form, I highly recommend this as it's quite difficult to get precise dosages once you get lower. I just switched over at such a low dose and regret not doing it sooner! I don't even want to imagine how all over the map my dosages were by trying to cut the tiny bits of pills. But, this journey is all a learning experience and luckily we have lots of experienced folks around here to help! Don't hesitate to reach out with any questions!

[Deean]

On 9/2/2022 at 12:33 PM, Timberline said:

Hi @Deean. Very wise of you to reach out here! ChessieCat has provided the best info for you to look over. One thing I can add from experience is that the lower you get, the slower you should go. So, lets be thankful that your previous method got you this far, but a change in course would be best! I've been tapering lexapro since June of 2020 and am .5mg from 10mg. The only time I ran into issues was when I got under the 1mg mark and decided to speed up the taper because I was so close to the finish line! Boy, what a bad idea. I am so thankful I got past that speed bump and can now continue to taper. If you're able to get your hands on the liquid form, I highly recommend this as it's quite difficult to get precise dosages once you get lower. I just switched over at such a low dose and regret not doing it sooner! I don't even want to imagine how all over the map my dosages were by trying to cut the tiny bits of pills. But, this journey is all a learning experience and luckily we have lots of experienced folks around here to help! Don't hesitate to reach out with any questions!

Timberline, thanks for chiming-in on this.  Lower I go, the slower.  Okay, roger that.  I can imagine it must have been tempting to speed up your taper so close to taking such a small amount...glad you were able to move past it. 

Obtaining the liquid form when getting to the low-dose, good advice. 

I am planning to do the homemade capsule to liquid to start with the Vyvanse.  Lot's of research to do on that. 😉  Unless I discover it is just as ineffective because I'm doing it on my own and not from a compounding pharmacy.  Although, I know it can be very pricey.  Will see what the research and experience of others shows.

Yes, so glad for this forum...how invaluable it is!

Thanks again Timberline!

But will definitely remember your advice on purchasing the liquid form at the lower mg point.  

[Deean]

Diluting powder (from a capsule) into a liquid

 

Hi there,

 

I am preparting to taper from Vyvanse (20 mg total dosage).  I have been researching and calculating...am making good progress on my preparations to taper Vyvanse.

I have used so many of the wonderful tools, recommendations, etc. on here..so fabulous!

 

I have a question about the dilution process.

Is it imperative that I know the weight of the capsule "contents" and the percentage of active ingredient verses filler contents in the capsule I am diluting?

 

My plan is to drop the powder contents of one capsule (10 mg) into distilled water (still figuring out the ratio of mg of drug to ml water) and then draw up the 90% in syringe once it is well mixed, etc. in order to do the 10% decrease.

Is there anything I am missing in this process?

 

Apparently the water solubility is "0.0877 mg/mL" (haven't checked multiple sources on this).

So if I have 10mg of capsule content...would the distilled water amount be:  8.77 ml?

 

Thanks in advance to anyone if you are able to assist me on this,

Dawn

 

Edited September 13, 2022 by ChessieCat
added Intro topic title before merging with intro topic

[ChessieCat]

SA's topic:

 

how-to-make-a-liquid-from-tablets-or-capsules

 

4 hours ago, Deean said:

Is it imperative that I know the weight of the capsule "contents" and the percentage of active ingredient verses filler contents in the capsule I am diluting?

 

The following information is provided without taking the solubility into account.  I suggest you post your question about this in the above topic and tag Brassmonkey.

 

If you are using the entire contents of the capsule you will not need to know the weight.  You only need to know the drug dose.  You have stated that the dose of a capsule is 10mg.  If you put 10mg dose in 10mL of water each 1mL of liquid will contain 1mg dose.

 

Generally homemade liquid can be keep covered in the refrigerator for 3-4 days.

 

To make it easier and to get a more accurate dose you can increase the amount of water.

 

Please double check my calculations

 

10mg --> 10mL then 1mL = 1mg

10mg --> 20mL then 1mL = 0.5mg

10mg --> 50mL then 1mL = 0.2mg

10mg --> 100mL then 1mL = 0.1mg

 

The easiest way to calculate your dose is to multiply the current dose by 0.9 for a 10% reduction, 0.95 for a 5% reduction, 0.99 for a 1% reduction.  So the first 10% reduction from 20mg would be 20mg x 0.9 = 18mg.  The next reduction would be 18mg x 0.9 = 16.2mg.

 

If you are currently taking 2 x 10mg capsules, you could take 1 x 10mg capsule + the rest as liquid.  For the first reduction to 18mg you could take 1 x 10mg capsule + 8mL of the liquid (10mg --> 10mL) which = 8mg.

 

To get the 16.2mg dose you could use the 10mg --> 50mL and take 1 x 10mg capsule + 31mL of liquid (=6.2mg).

[Deean]

3 hours ago, ChessieCat said:

SA's topic:

 

how-to-make-a-liquid-from-tablets-or-capsules

 

 

The following information is provided without taking the solubility into account.  I suggest you post your question about this in the above topic and tag Brassmonkey.

 

If you are using the entire contents of the capsule you will not need to know the weight.  You only need to know the drug dose.  You have stated that the dose of a capsule is 10mg.  If you put 10mg dose in 10mL of water each 1mL of liquid will contain 1mg dose.

 

Generally homemade liquid can be keep covered in the refrigerator for 3-4 days.

 

To make it easier and to get a more accurate dose you can increase the amount of water.

 

Please double check my calculations

 

10mg --> 10mL then 1mL = 1mg

10mg --> 20mL then 1mL = 0.5mg

10mg --> 50mL then 1mL = 0.2mg

10mg --> 100mL then 1mL = 0.1mg

 

The easiest way to calculate your dose is to multiply the current dose by 0.9 for a 10% reduction, 0.95 for a 5% reduction, 0.99 for a 1% reduction.  So the first 10% reduction from 20mg would be 20mg x 0.9 = 18mg.  The next reduction would be 18mg x 0.9 = 16.2mg.

 

If you are currently taking 2 x 10mg capsules, you could take 1 x 10mg capsule + the rest as liquid.  For the first reduction to 18mg you could take 1 x 10mg capsule + 8mL of the liquid (10mg --> 10mL) which = 8mg.

 

To get the 16.2mg dose you could use the 10mg --> 50mL and take 1 x 10mg capsule + 31mL of liquid (=6.2mg).

Thank you so much for all of this ChessieCat!  

I will re-read and double check your calculations once I figure out how to do that. heehee  I'm learning.

I will post that query in the how to make a liquid...topic.

I am not sure how to "tag"...I will try to put my tech-goggles on 😉

 

[ChessieCat]

3 minutes ago, Deean said:

I am not sure how to "tag"...I will try to put my tech-goggles on 😉

 

Type an @ symbol and then type the member's name.  From the list that pops up below, click on the member you want.

 

3 minutes ago, Deean said:

Thank you so much for all of this ChessieCat!  

I will re-read and double check your calculations once I figure out how to do that.

 

You are welcome.

 

My suggestion would be to write it down on paper so that you can see the pattern which can help you to understand how it works.

 

Hint:

 

10mg --> 50mL then 1mL = 0.2mg

 

To get the 0.2mg you divide both sides by the mL, in the above you divide both sides by 50 so that you end up with 1mL and the other side is the dose that the 1mL of liquid will contain.

 

To get the 16.2mg dose you could use the 10mg --> 50mL and take 1 x 10mg capsule + 31mL of liquid (=6.2mg).

 

To work out the amount to take you divide the dose you need by the 0.2mg.  So in the above you divide 6.2mg by 0.2mg which is 31mL.  To double check you then multiple 31mL by 0.2mg to get 6.2mg.

 

[Deean]

2 minutes ago, ChessieCat said:

 

Type an @ symbol and then type the member's name.  From the list that pops up below, click on the member you want.

 

 

You are welcome.

 

My suggestion would be to write it down on paper so that you can see the pattern which can help you to understand how it works.

 

Hint:

 

10mg --> 50mL then 1mL = 0.2mg

 

To get the 0.2mg you divide both sides by the mL, in the above you divide both sides by 50 so that you end up with 1mL and the other side is the dose that the 1mL of liquid will contain.

 

To get the 16.2mg dose you could use the 10mg --> 50mL and take 1 x 10mg capsule + 31mL of liquid (=6.2mg).

 

To work out the amount to take you divide the dose you need by the 0.2mg.  So in the above you divide 6.2mg by 0.2mg which is 31mL.  To double check you then multiple 31mL by 0.2mg to get 6.2mg.

 

This is great! 

Appreciate the math break-down.  Much helptul 🙂

I figured out how to tag BrassMonkey - Yaay!

Alright, will go through your instructions and learn.

Thanks again!

[Deean]

Vyvanse taper-1st month experiences

 

Started my taper of 10% of my regular dose of Vyvanse last month, on October 1st.  Since near the end of October, I am sitting for a 1 month hold.

 

Withdrawal symptoms seemed to be most intense during the 2nd and 3rd week...things have levelled off in the last week or so.

 

Mainly experienced mild head pressure, (like having head in a vice), some insomnia,

nausea, motion sickness, afternoon lethargy, ringing in ears and irritability.  All fairly manageable at this point.

 

Have gotten into a rhythm with making liquid med from capsule powder. Feeling more confident about the process. 

 

Thanks again ChessieCat and Brassmonkey for your words of experience and care.

Anyway, hope this may help in some way to anyone preparing to taper Vyvanse.   

 

Edited November 4, 2022 by ChessieCat
added topic title before merging with intro topic

[Deean]

small white ball of powder in capsules

 

My latest prescription of Vyvanse has had some powder and some conjealed powder in the shape of a loose ball in each capsule I have opened and made into liquid form.

 

It always dissolves, however, I am wondering if anyone has experienced this? Or might know why the capsule powder contents is not "all" loose. 

 

I have phoned the pharmacist, but they weren't sure.

 

I will call the company tmw and ask.

 

Edited November 4, 2022 by ChessieCat
added topic title before merging with intro topic

[Deean]

On 11/3/2022 at 3:38 PM, Deean said:

Vyvanse taper-1st month experiences

 

Started my taper of 10% of my regular dose of Vyvanse last month, on October 1st.  Since near the end of October, I am sitting for a 1 month hold.

 

Withdrawal symptoms seemed to be most intense during the 2nd and 3rd week...things have levelled off in the last week or so.

 

Mainly experienced mild head pressure, (like having head in a vice), some insomnia,

nausea, motion sickness, afternoon lethargy, ringing in ears and irritability.  All fairly manageable at this point.

 

Have gotten into a rhythm with making liquid med from capsule powder. Feeling more confident about the process. 

 

Thanks again ChessieCat and Brassmonkey for your words of experience and care.

Anyway, hope this may help in some way to anyone preparing to taper Vyvanse.   

 

I called the company that makes the Vyvanse.  They have been very diligent about launching what they call an "investigation" into why this is happening.  Pre-investigation, they have told me that it is normal sometimes to see a compacted powder in the capsule, however, they couldn't say if it was the same amount each time.  I let them know that it is the first time that I have experienced this  since I began taking Vyvanse over 4 years ago.  When I hear back, I will send an update.