The Brassmonkey Slide Method of Micro-tapering

[Kelsears]

I take 7.5mg of Zoloft daily. I’d like to do sliding method. But how do I measure out a dose of 7.32 of my liquid Zoloft (this is made by pharmacy and has to be taken in water or will cause numb tongue). 

[LostInCanada]

@Kelsears you mentioned you use a 1 ml syringe so how do you measure 7.5 mg now? Is it 1 mg per 1ml? Do you fill the syringe 7 and 1/2 times? If that is the case, you would fill the syringe 7 times and then fill the syringe the last time to 3 plus 1 little line up from the 3 ( between the 3 and 4) instead of to the 5. I am assuming your syringe is marked by 10-0.01 ml marks and that between the 0.1 ml marks is 5 smaller marks.

[brassmonkey]

What is the volume (mL) of the 7.5mg that you are adding to the 60mL of water?

 

There are several steps to this process, but if you take them one at a time it will be easy.

 

Subtract the above volume from 60. This will give you the new volume of water to mix with the 7.5mg liquid to give a total volume of 60mL. You were close Bastringue, but there is a subtle difference.

 

This new mixture will give you 1mg of active ingredient for every 8mL of liquid. Drink all of it and you get a full dose of 7.5mg. Drink less and you get a smaller dose.

 

To reduce by 2.5% for the first week of the Brassmonkey Slide. Multiply 60 times 0.975. (60 X 0.975 = 58.5) So, 58.5 is the new volume of your dose. You will remove 1.5mL from the total liquid and throw it away, now drink what is left over.

 

For the second week of the Brassmonkey Slide you will reduce by 5% of the total. (60 X 0.95 = 57) You would remove 3mL from the total and throw it away and drink the rest.

 

For the third week of the Brassmonkey Slide you will reduce by 7.5% of the total. (60 X .925 = 55.5) You would remove 4.5mL from the total and throw it away and drink the rest.

 

For the fourth, fifth and sixth weeks of the Brassmonkey Slide you will reduce by 10% (60 X 0.9 = 54) You would remove 6mL from the total and throw it away and drink the rest.

 

For the next cycle of the Brassmonkey Slide you would do the same calculations except you start with 54 instead of 60. (54 X 0.975= X) (54 X 0.95 = X) (54 X 0.925 = X) (54 X 0.9 =X) Each time you would remove (6 + X) from the original 60mL of liquid.

 

Like I said, it looks tricky, but if you take it one step at a time it's pretty easy.

[LostInCanada]

@brassmonkey the solution is already premade at the pharmacy. @Kelsearsonly adds the 7.5 mg to water so her tongue won't numb.

[Kelsears]

@LostInCanada

@brassmonkey

 

The solution is 20mg to 1ml. I fill the syringe to the .33 ml line. Ive shown it on the photo with a green line. 

[LostInCanada]

@Kelsears can you ask the pharmacy to make the solution 10mg to 1ml? That would make it much easier.

[Kelsears]

@LostInCanada

no this is the only way I can get it through my insurance. 

[brassmonkey]

If you add 1mL of pharmacy solution to 19ml of water, you will get a 1:1 solution. This solution gives you 1mg active ingredient for each 1mL of solution. Then you just take a dose volume equal to the desired dose strength.

[Kelsears]

@brassmonkey

ok I think I get it so take 60ml water subtract the 7.5mg(for medication room) to keep 60ml of solution. Then use your taper rate to calculate the amount of liquid to remove for the taper? 
would it be bad to go even slower and do a 1% cut until I know how my body will react to the tapering? I have total PTSD from being cut cold Turkey. 
 

thank you for all your help. 

[brassmonkey]

You've got it. Yes, a slower rate would be fine.

[LostInCanada]

Just curious if a 5% cut every two weeks would work more gently than a straight 10% but not take as long as the 2.5% weekly with the two week hold? I just hate the idea of being 5 more years on this drug but at the same time I do not want a repeat of the CT WD. Hope you are feeling better brass.

[brassmonkey]

Our baseline of 10% every four weeks has evolved over many years of trial and error, and is just that, a baseline. For most people it is still too fast, but going faster causes problems for everyone who tries. It has two main problems, the shock of the initial reduction and not enough time for the resulting symptoms to resolve before the next reduction.

 

A taper of 5% every two weeks would reduce the initial shock, but still not allow enough time for the symptoms to resolve before the next reduction. Some people could get away with it, but for those that can't, it would end up taking a lot longer than a slower taper. With faster tapers there are unresolved symptoms that build up in the background. These go unnoticed until they reach a critical point at which they cause a destabilizing crash. To restabilize the person must hold for an extended time, often six to eighteen months, before they can resume tapering. They are frequently left in s sensitized state and have to taper smaller and slower or risk crashing again. In the end the faster taper frequently results in several more years being required than a slow taper would take. Not to mention that crashing and restabilizing are not pleasant experiences.

 

For a ballpark calculation the half-life of the baseline taper is 6 months. While the half-life of the Brassmonkey Slide is nine months. I tapered using the Brassmonkey Slide from 40mgai of Paxil with one slightly extended hold at 10mg. It took me five and a half years to get to a safe jumping off point.

[Mutfael]

3 hours ago, brassmonkey said:

Our baseline of 10% every four weeks has evolved over many years of trial and error, and is just that, a baseline. For most people it is still too fast, but going faster causes problems for everyone who tries. It has two main problems, the shock of the initial reduction and not enough time for the resulting symptoms to resolve before the next reduction.

 

A taper of 5% every two weeks would reduce the initial shock, but still not allow enough time for the symptoms to resolve before the next reduction. Some people could get away with it, but for those that can't, it would end up taking a lot longer than a slower taper. With faster tapers there are unresolved symptoms that build up in the background. These go unnoticed until they reach a critical point at which they cause a destabilizing crash. To restabilize the person must hold for an extended time, often six to eighteen months, before they can resume tapering. They are frequently left in s sensitized state and have to taper smaller and slower or risk crashing again. In the end the faster taper frequently results in several more years being required than a slow taper would take. Not to mention that crashing and restabilizing are not pleasant experiences.

 

For a ballpark calculation the half-life of the baseline taper is 6 months. While the half-life of the Brassmonkey Slide is nine months. I tapered using the Brassmonkey Slide from 40mgai of Paxil with one slightly extended hold at 10mg. It took me five and a half years to get to a safe jumping off point.

I did the reduction and reduce the dose over a period of two years, but the symptoms were very severe, so I could not bear it, as a cup of tea could cause me fatigue, heart palpitations, and very severe anxiety!!  Then I went back to 20 mg of Seroxat, so what is the solution in your opinion.. Thank you

[brassmonkey]

I'd try a Brassmonkey Slide at 1.25% a week for four weeks and then a two week hold. You are going to get symptoms no matter what. It might take some experimentation to find the sweet spot for your taper, where they are manageable.

[possum]

I have been doing the standard 10% decrease of Paxil for the past few months and am currently at 12 mg (updosed from 11.8 due to very severe WD). It has been suggested, and I agree, that I try the Brass Monkey slide from here on in, since Paxil withdrawal seems harder to deal with at the lower doses. My problem is, I am a total idiot when it comes to spread sheets. Can someone recommend a calculator I can use that won't make me even crazier than I am? I am making my own liquid so the smaller amounts shouldn't be a problem. Many thanks.

[LostInCanada]

@possumthe very first post on this subject has calculators and spreadsheets 👍

[rd57]

Hi, 

 

I’m coming to the end of the second week of the second slide (coming off fluoxetine). Decided on a 4% reduction over the 4 weeks and a hold for the remaining two. For the first slide, WD symptoms hit in the middle of the second week and didn’t really go until the end of the sixth week. I’m now coming to the end of the 2nd week of the 2nd slide, and fear I’ve overstretched myself; bit too much to drink, too much exercise, etc,. Headaches I got from the end of the first week haven’t gone and other WD symptoms have now surfaced and intensified. Coming to the end of the second week, I technically should be making another 1% reduction, but considering the symptoms, should I hold at the last reduction or even updose?

[brassmonkey]

@rd57 you always want to taper from a place of stability. I would hold for a couple of weeks to let things settle down, and then restart your taper. No more drinking. It is the best way there is to derail a good taper.

[dealwithadil]

I started with the classic method of 10% per month. And indeed, with each new reduction, the following days, I do not feel well. In general, I feel that I went too fast with my plan, doesn't suit with me. I had decided to take a break from 1mg for a few weeks or even months before I found this article. This method sounds better to me. 

 

@brassmonkey

As you say in your initial article: "if we don't allow time for these changes to be made properly they pile up and pile up until there are just too many of them." I feel like I'm at this stage of the journey. 

 

In this case, do you advise starting with your method from a higher dose? (in my case, starting from the minimum effective dose of 1,5 mg to restart properly), or is it that if given time (a few weeks or months), the body will be able to make the readjustments that have piled up during previous reductions, then we can start from the current dose with the new method with a lower pace? (1,25% per week for example instead of 10% per month). 

 

[brassmonkey]

There is no need to updose unless your symptoms are out of control. I would suggest a nice long hold, possibly several months, to let things settle down and then give the new taper a try.

[LostInCanada]

Question @brassmonkey if I am in the middle of a slide, say week 3 day 5 and a wave hits (my waves last 7-10 days), should I just wait for the wave to finish before continuing the slide? Or should I just do my 2 week hold after that 3rd reduction and start a new slide once the wave and hold passes? Thanks 

[Iowan]

@LostInCanada, from my own personal taper history and all of the other responses I've read here, I suggest holding and not reducing your dosage while you're in a wave. A wave indicates that your brain and body are emitting signals of shock that something is off and needs attention. Pause at the dosage you're at. Give yourself time to recover and pull through the wave before continuing to reduce your dosage.

 

I paid the price every time I personally attempted to speed up the process or force myself through a wave. It's best to play the long game with tapering off of ADs.

[LostInCanada]

Thanks @Iowan appreciate it 

[dealwithadil]

On 8/13/2023 at 8:03 PM, brassmonkey said:

There is no need to updose unless your symptoms are out of control. I would suggest a nice long hold, possibly several months, to let things settle down and then give the new taper a try.

Ok thank you @brassmonkey I'll do that 👍🏻

[brassmonkey]

A hold is a good thing whenever you don't feel right. Tapering out of a wave never works, wo it is best to stay put for a while until things settle down.

[littlebird]

8 minutes ago, brassmonkey said:

A hold is a good thing whenever you don't feel right. Tapering out of a wave never works, wo it is best to stay put for a while until things settle down.

Thanks, I needed to read this. I think I might be in the "what if the wave never gets better and I'm holding forever" mindset, but the only constant is change and it's likely I just need a nice long hold to see how things settle down. I see my new psychiatrist Friday and she's expecting me to be fully off Wellbutrin, but that doesn't mean I need to taper again to get closer to that goal. She can meet me where I'm at.

[Boges11]

Been on Mirtazapine almost 5 weeks now ….. had a hell of a last few months being spiraled thru various meds after horrific akathisia after long slow taper of K.

How does one attempt a taper when severe akathisia is happening? 

not sure if Mirtazapine is making things worse. I don’t know how to tell what’s causing what now. I don’t want to be on something that is keeping akathisia going but I know coming off quickly could basically derail me completely. I’m so lost and scared bed bound and severe internal and external akathisia and now twisting body movements and hypnic jolts, bad eye issues etc.

thank you.

 

 

[LotusRising]

@Boges11

 

I tried pregablin for about 4 weeks while I was tapering clonazepam, but ultimately decided that since it wasn't helping me, I didn't want to stay on it, so I discontinued it very quickly by reducing my dose 25% every week. I was very destabilized at the time from my clon taper, but in my experience, I didn't get any worse.

 

If that seems too much, you could also try a 10% reduction to see how you do.

 

 

[Boges11]

Thanks I’m mad at myself bc it was only 2 1/2 weeks when I first got on here and asked and I thought it was 3 1/2 at the time…. now it’s 4 weeks so I could have stared making a change then with less time.

 

not sure if I should.change to liquid right now ….. I’m scared bc I have such lack of impulse control and screaming/rage with the aka. 
 

[bastringue]

Whatever you do, go sloooooowwww. I had some success with the 2.5% taper for 4 weeks and then 2 weeks off. Maybe it could work for you. Be sure to add some supplements (like D3, K2, and omega-3), eat well and go outside and walk briskly (or any other exercise) at least 30 minutes every day. Godspeed.

[Emonda]

FYI - I've made an error merging one post into this member's thread....it is being resolved...

[Daniel1269]

@brassmonkey
 

Please can you advise if the 2.5% per week reduction could be split into 5% every two weeks with the two week hold at the end?

 

I don’t have that level of accuracy due to being denied liquid and can only measure whole numbers with 0 decimal places.

 

i.e from 50mg, to 47mg for two weeks, then 45mg for two weeks, then a two week hold. (I know it’s not quite 5% reduction on the first week but you get the jist, it is the most accurate I can be)

 

Thanks.

[brassmonkey]

It wouldn't be a Brassmonkey Slide, but it would work.

 

How are you measuring your doses that you can't be accurate enough?

 

[Daniel1269]

27 minutes ago, brassmonkey said:

 

How are you measuring your doses that you can't be accurate enough?

 

via Gemini mg scale, only goes to 0.001g, is this still acceptable the 5%( ish) every two weeks with the two week hold?

[brassmonkey]

This scale is the one that most members are using, it works quite well, but has a bit of trouble with the Endgame Taper.

 

As I mentioned above the 5% every two weeks would work fine, but you need to throw in a hold period too.

[Tridentata]

Could use a bit of input on what to do when "cheating" on the Brassmonkey Slide causes problems. By "cheating" I mean: for most of 2023 I came slowly down from 3 mg amitriptyline to 1.2 mg at year's end, between March and December following a strict 2.5% reduction each week plus 2-week hold every four weeks per protocol. Was quite stable with mild waves for the last three months of 2023, so on 1/1/24 I decided to speed up the taper a bit by going down 20% from 1.2 mg to 1.0 mg in four weeks, followed by two-week hold. Did that, started getting more frequent waves, so I decided to hold at 1.0 for a while.

 

It has been 5 weeks at the 1.0 hold and the wave symptoms (sleep disruption mainly) are not improving, indeed becoming more consistent, so I'm wondering whether it's time to updose, perhaps back to 1.2 (which would be a 20% jump), or at least to 1.1 (10% jump). I've recently purchased the Horowitz and Taylor book Deprescribing Antidepressants, and while they don't give fixed guidelines, they suggest either a 6-week hold in case of moderately severe symptoms, or for some patients an increase "either part way, or all the way back to the dose at which they were previously stable", followed by a slower taper. I've learned my lesson about taper speed, so just wondering whether anyone has thoughts about the decision to hold vs. updose in general in cases like this.