bastringue: Is my tapering strategy good?

[bastringue]

Thanks

Edited October 2, 2022 by bastringue
please delete... I wrote two messages, it was a mistake

[bastringue]

Thanks!

 

Yesterday I felt so bad I took 5 mg amitriptyline before bed. My new strategy would be:

 

- amitriptyline 5 mg and then taper 2.5% per week for 4 weeks and hold for 2 weeks;

- duloxetine going back up to 53 mg (as suggested) and taper the same way.

 

Do you think it could work and help me feel better? Is it safe to slowly taper both at the same time?

[Altostrata]

I would not mix up a drug cocktail by adding amitriptyline. Suggest you try this first:

On 9/28/2022 at 5:49 PM, Altostrata said:

....

Up to you whether you want to updose slightly, perhaps to 53mg, or ride out your withdrawal symptoms. If I were you, I would not reduce any further until after your withdrawal symptoms go away. Suggest you stop caffeine as well, since it seems to exacerbate your problems.

....

 

Please be aware your withdrawal effects probably were exacerbated and refreshed by your drinking alcohol. Simply letting your nervous system settle down may be the wisest course. We would not advise taking an additional drug to reverse the effects of alcohol.

[bastringue]

1 hour ago, Altostrata said:

Please be aware your withdrawal effects probably were exacerbated and refreshed by your drinking alcohol. Simply letting your nervous system settle down may be the wisest course. We would not advise taking an additional drug to reverse the effects of alcohol.

 

Thank you...

 

If I may ask... I don't understand the thing about alcohol. You also said something about it on the other page. I didn't have one drink since I started to taper down my med. Not one! How can alcohol be a problem if I don't drink anymore? You say that the problem has been 'refreshed' by me drinking alcohol, but I haven't drink alcohol since I started tapering down, over two months ago, so how can it be 'refreshed'? Maybe I miss something, as my English isn't that good, but I don't get it...

 

Since I took Elavil yesterday, so I shouldn't take it anymore if I understand correctly? I just up duloxetine to 53 mg and hope that the Elavil withdrawal will go away and don't take it anymore? 

 

More to the point: if my main symptoms are from Elavil withdrawal, when I went from 10-20 mg to 0 in a couple of weeks, wouldn't it make sense to reintroduce it? I just want to understand: how can my symptoms come from going from 60 mg duloxetine to 51 mg, rather than Elavil fast tapering? What is the rationale for not reintroducing Elavil and trying to taper it down correctly this time?

 

Thank you very much for trying to help me.

 

 

[Altostrata]

39 minutes ago, bastringue said:

I haven't drink alcohol since I started tapering down, over two months ago

 

You have been changing your drugs and drinking alcohol intermittently for years. This combination might have made your nervous system vulnerable to dysregulation from more recent drug changes.

 

Two months of no alcohol is not a very long time. Stabilization can take months with NO drug changes or alcohol upsets.

[bastringue]

OK, I understand. Thank you for the explanation.

 

I'll think about all this.

 

I thought I did a smart move by reintroducing amitriptyline yesterday. I feel so bad I don't think simply going from 51 mg duloxetine to 53 mg duloxetine would be enough. That's why I thought doing the amitriptyline tapering correctly would have been the best idea. I had the best night in close to two months last night. Didn't wake up relaxed (I never do), but as in bed for 10 hours and didn't feel as sleepy as usually. So I thought I was on the right track; I thought maybe the amitriptyline fast tapering was the root cause of the problem. So that's why I was surprised when you said not to reintroduce it. I am so confused now. :/

 

So... Since I took amitriptyline 5 mg yesterday, would you still suggest I forget about it, bite the bullet, and stay on duloxetine 53 mg and wait for symptoms to improve, or do I need to taper amitryptiline again? I really think my symptoms are more about amitryptiline withdrawal than duloxetine withdrawal.

[Altostrata]

14 minutes ago, bastringue said:

I had the best night in close to two months last night. Didn't wake up relaxed (I never do), but as in bed for 10 hours and didn't feel as sleepy as usually.

 

Ordinarily, it's a bad idea to take a TCA with an SNRI. However, since you got this good result, perhaps 5mg amitriptyline will be helpful without much risk of the drug combination, it's a very low dose. 

 

Let's see how it goes over a week, it will take that long for the 5mg amitriptyline addition to reach steady-state. Be sure to take your drugs at the same times each day.

 

Perhaps this will enable your duloxetine taper.

[bastringue]

Why at the same time each day? I take duloxetine in the morning and amitriptyline right before bed, because it helps me to sleep.

 

OK I will try for one week, see how it goes.

 

Thank you very much!

[ChessieCat]

Alto doesn't mean for you to take both drugs at the same time.  She means that you take each drug at the same time every day.  So if you take one drug at, for example, 7am and the other drug at 9pm keep to that timetable.

[bastringue]

25 minutes ago, ChessieCat said:

Alto doesn't mean for you to take both drugs at the same time.  She means that you take each drug at the same time every day.  So if you take one drug at, for example, 7am and the other drug at 9pm keep to that timetable.

 

Ah, OK, thanks, now I understand!

 

Will see in a week how it works.

 

Thanks for the help and thanks for this website!

[bastringue]

It's been over a week now and I feel better having reintroduced amitriptyline at 5 mg and upped duloxetine at 53 mg. Will stay the same next week and then slowly taper down. I think I went too quickly with amitriptyline.

[ChessieCat]

4 hours ago, bastringue said:

Will stay the same next week and then slowly taper down.

 

I think it might be a good idea to hold off reducing again for at least 2 months, possible 3.  It is better to start from a place of stability than to start reducing again too soon.

[bastringue]

That would slow me down so much... I feel better now, and would taper down really slowly...

[ChessieCat]

It's your brain that determines how fast you go.  I've been a member here for nearly 7 years and I've seen SA members who have tried to get off their drug too quickly and it has ended up taking them longer than if they had done a nice steady and slow taper.  Some have ended up changing drugs (which doesn't always work) and some have ended up taking an additional drug/s (which then need to be tapered).  Many of these members have stated that they regret not tapering more carefully and of course they have to cope with any bad effects/withdrawal effects during that time that they might not have experienced.

 

The goal of tapering is to get off with minimal discomfort and be able to live your life as normally as possible during that time.  It has nothing to do with how strong or determined you are as a person.

[bastringue]

Yeah, I know, but I think that if I go really slowly, using the brassmonkey method, could it work? I feel really better now, and after 3 weeks at the current dose, wouldn't it make sense to at least try to taper a little bit, 2.5% for example? If I feel bad, wouldn't I simply have the option to get back to previous dose?

[ChessieCat]

Look back at your drug history for 2022.  You have made a lot of changes.  The effect of going on and off psychiatric drugs has a cumulative effect on the nervous system.  We have SA members who when on and off their drugs multiple times and then one day they do the same thing they did before and things got worse because the nervous system is not able to cope.

[bastringue]

Yes, I know, you are right... But why wouldn't slooooowly tapering after 3 weeks at the same level be a bad idea? Why waiting for months?

[ChessieCat]

1 minute ago, bastringue said:

But why wouldn't slooooowly tapering after 3 weeks

 

Because of the following very recent THREE major changes:

 

2021-2022 : mirtazapine 5 mg (when insomnia, not every day). CT in August 2022.

October 2022: reintroducted amitriptyline 5mg and duloxetine up from 51 to 53 mg.

[Altostrata]

On 10/11/2022 at 9:40 AM, bastringue said:

It's been over a week now and I feel better having reintroduced amitriptyline at 5 mg and upped duloxetine at 53 mg. Will stay the same next week and then slowly taper down. I think I went too quickly with amitriptyline.

 

Why did you increase duloxetine?

 

Please make only one drug change at a time and then observe the effect. If you make more than one change at a time, you can't tell which change was beneficial (or caused problems).

 

Suggest you not make any drug changes for at least a month to see what these changes do.

[bastringue]

I had the advice to get it up to 53 mg.

[Altostrata]

Sorry for the misunderstanding. Advice should have been increase duloxetine OR add a little amitriptyline.

 

Did you add amitriptyline and increase duloxetine one the same day? How many days has it been? What times o'clock do you take your drugs, with their dosages?

[bastringue]

Yes I added both on October 1st, amitriptyline at night and duloxetine in the morning.

[Altostrata]

How are you feeling now?

[bastringue]

Good, pretty normal, like nothing happened. As soon as I reintroduced amitriptyline at 5 mg, I began to feel better. Anxiety is down (still high, but I always had high anxiety... right now I can manage), I don't shake anymore, I don't feel off, I feel pretty 'normal'. I'm up for another week next week at the same level and I'll think about what's next then... But I hear you, I know I should not mess too much with this...

 

Honestly, I always thought that amitriptyline worked better for me than duloxetine. I hate duloxetine so much... 

 

Thanks for asking how I feel!

[Altostrata]

Sounds like you had amitriptyline withdrawal and it was unnecessary to increase duloxetine. Oh well.

[bastringue]

Yeah, what's 'funny' is how much time it took to get those amitriptyline withdrawal symptoms.

 

Luckily, only went from 51 mg to 53 mg duloxetine so it wasn't too much of an increase.

 

I still do not feel perfect, but I feel fine enough to try to slooooooooowwwwwllllly taper down. I know I shouldn't take caffeine, but took some for a couple of days and didn't have extreme reaction. Everything seems to be back to somehow 'normal' now.

 

Will try to taper down 2.5% next week, and try brassmonkey method, and if it doesn't go well I will stabilize for much longer than three weeks that time.

 

I need to keep my motivation going.

 

Thanks for helping me and I hope you understand... 

[Altostrata]

If I were you, I would not make any more drug changes for at least a month.

[bastringue]

The taper will be so slow it won't make much of a difference IMO. I will have waited at least 3 weeks, which is close enough for a month I believe... 

[ChessieCat]

3 weeks = 21 days

4 weeks = 28 days

 

There is a 25% difference.

[bastringue]

A quick update: I am now at 45.4 mg duloxetine and 4.4 mg amitriptyline and I feel really fine. Actually, I feel better right now with those lower doses and with magnesium, D3 and omega-3 than I felt before I started to taper. I am still using the brassmonkey method and it works really well. I feel absolutely no difference from one day to another or one week to another.

[bastringue]

Still going strong : 22.1 mg duloxetine and 2.4 mg amitryptiline. I went from a 2.5% weekly tapering to a 5% weekly tapering (with two "rest" weeks after each 4 weeks) in May and June, and now back to 2.5% because I exercise a bit less and it's less sunny. I still feel fine, albeit slightly less energy and a little bit more depressed than a couple of weeks aqo. Still, it seems to work. Slow and steady wins it.

[Altostrata]

Good to hear. Please let us know how you're doing. 

[bastringue]

Hi,

 

I have a question. I'm going on with the Brassmonkey method and am now down to 9.8 mg duloxetine and 0.8 mg amitryptiline.

 

My question is concerning amitryptiline: would it be safe to go from 0.8 mg to 0 faster than what was expected? It's kind of pretty low dose. Or what about simply going on until 0.5 mg and then stopping? 

[Erimus]

56 minutes ago, bastringue said:

Hi,

 

I have a question. I'm going on with the Brassmonkey method and am now down to 9.8 mg duloxetine and 0.8 mg amitryptiline.

 

My question is concerning amitryptiline: would it be safe to go from 0.8 mg to 0 faster than what was expected? It's kind of pretty low dose. Or what about simply going on until 0.5 mg and then stopping? 

I wouldn't. When you get to the really low doses the changes in the brain are much more profound. Everyone gets the temptation to go faster when things are going well, the important part is resisting the urge. I would go down to at least 0.1mg before considering jumping.

[bastringue]

Just now, Erimus said:

I wouldn't. When you get to the really low doses the changes in the brain are much more profound. Everyone gets the temptation to go faster when things are going well, the important part is resisting the urge. I would go down to at least 0.1mg before considering jumping.

 

OK thanks, will do.