Mcat: reinstated Mirt, now coming down again

[Mcat]

Hi, I was on 7.5mg Mirt for 8-9 months till early Jan 2023, when I started titrating down due to developing a concerning side effect. I probably didn't do it slowly enough as I got bad rebound insomnia and anxiety (the insomnia was the real killer), so I went back on 7.5mg on the advice of psych, who didn't think the symptom was a side effect of the drug. She told me to go to 15 after a week, which I did. Been back on 9 nights, and not only has the original problem side effect returned, but another related one is present. So, now I want to come back down again. Do people here think it's okay for me to go from 7.5mg to 3.75 now? I want to see if the symptom persists on that dose, as I've read here lower doses can prove effective in reducing WD. If it does, I might have to come off it altogether. I don't think I could manage the liquid weaning because I'm very challenged with maths and things like that (despite having 3 degrees - humanities person, haha). I would appreciate any guidance on how to come off slower without liquid. 

Edited March 6, 2023 by Karma
Name update

[Gridley]

Welcome to SA, Mcat.

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements.  A list format is best.

 

Account Settings – Create or Edit a signature.

 

Are you on 15mg now?  Please put that dose and the date you started 15mg in your signature.

 

What are the side effects and how bad are they?

 

Getting down lower in your case is a question of weighing the negative side effects vs. the risk of withdrawal symptoms, which can be severe and long-lasting.  In general, we recommend tapering by no more than 10% of your current dose every 4 weeks.  

 

Why taper by 10% of my dosage?

 

Since you've been on 15mg for only 9 days, it's possible you can drop back down to 7.5mg without ill-effect.  You'll have to decide.  If you do that, I'd hold there for at least a month to stabilize before going lower.  I wouldn't drop from 7.5 to 3.75.  That's too fast.  I'd follow the 10%/4 weeks rate to get lower from 7.5.

 

I'm math-challenged too.  You can taper by cutting pills or--better idea--weighing doses using a digital scale, such as the Smart Weigh scale available on Amazon.  That's how I've been doing my tapers.  Here's the link about tapering Mirt:

 

Tips for tapering off mirtazapine (Remeron)

 

Here's the pertinent information about splitting tablets and weighing doses.

Reduce by splitting tablets
Request that your prescription be filled with the lowest dosage tablets or combination that includes the lowest dosage and split them into quarters for the smallest decrements. (A quarter of a 7.5mg tablet would be 1.875mg.) If you are very sensitive to dosage reductions, you may wish to weigh tablet fragments, see Using a digital scale to measure doses

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium (glycinate is a good form) and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.This is your introduction topic -- the place for you to ask questions, record symptoms, share your progress, and connect with other members of the SA community.  I hope you’ll find the information in the SA forums helpful for your situation.  I'm sorry that you are in the position that you need the information, but I am glad that you found us.

Edited March 6, 2023 by Karma
Name update

[Mcat]

Hi Gridley, thanks for your response. I've also discovered, via the FB group, that you can get a doctor to mediate reduction via a compounding chemist, so I'm going to look into that as I think the liquid measuring is beyond me and even trying to do it in pill form messes with my head. My dilemma now is, having stupidly (through confusion and fear) slid up and down between 7.5 and 15 for the first 9 days of reinstatement (and it worked for sleep well every one of those nights), I went back down to 7.5 last night after only 1 night on 15 (and several nights of 3/4 of a 15mg tab before that), and I couldn't sleep at all. Took a quarter of Temazepam to sleep and still only got about 4-5 hours. This scares me, as I've always been able to sleep well on 7.5 (and insomnia was why I went on it in the first place). The reason I tried to come down again was the very problematic side effect I was getting last year, which caused me to come off - hypnic jerks, involuntary and sometimes intense limb/muscle twitches that got so bad they were stopping me from sleeping and giving me a sleep complex - kicked back in after a week back on. So now I don't know what to do - go back to the 3/4 and start a compounding chemist taper from there or hang in with the 7.5 to see if sleep improves. I'm hoping someone has some experience with this kind of reinstatement story and can help. I wish I had known about these groups earlier as I've had so much bad advice from GPs and the psychiatrist I saw recently who said she didn't think the jerks were from Mirt and suggested I go back on it (they had just settled down after 6 weeks off it - my big problem at that point was I wasn't sleeping from the Mirt WD and stress of it all was so exhausted I couldn't think straight - she said if it gave me the jerks again, I could just come straight off 15mg when experience has shown even reducing that by half appears to be causing significant problems. I know I'm not alone in getting bad advice from medical professionals who don't seem to know what they're dealing with when it comes to these meds, so I hope to get some support here for what to do now. 

[Mcat]

PS: I don't understand the concept of kindling - can anyone enlighten me? 

[Gridley]

On 3/4/2023 at 11:19 AM, Mcat said:

So now I don't know what to do - go back to the 3/4 and start a compounding chemist taper from there or hang in with the 7.5 to see if sleep improves.

I would hang with the 7.5 for at least a month to let your system stabilize after going up and down in dose.  This "sliding dose" is hard on the nervous system, and right now it's very sensitized.  A likely explanation as to why your sleep isn't as good now on 7.5 as it was previously is that it became sensitized/destabilized by the bump-up to 15 and the inconsistent doses for the last several days.  

 

Using the compounding pharmacy is a good idea.

 

To emphasize, I wouldn't start the taper using the compounding pharmacy for at least a month, until you've stabilized.  Stay with your old 7.5mg pills during that time.  Then when you do switch to the compounded pills, I'd stay at 7.5mg compounded pill for two weeks to get used to the new type of pill.  These drug delivery systems are all different, and you only want to make one change at a time.  This minimizes stress on the nervous system. 

 

 

 

On 3/4/2023 at 11:28 AM, Mcat said:

I don't understand the concept of kindling - can anyone enlighten me? 

 

Kindling is basically trauma to the nervous system caused by going on and off a drug or increasing or decreasing (or both) a drug.  

 

Be very careful with the Temezapam.  These benzos are a slippery slope, especially with sleep (I've been there), and you can become physically dependent with 2 weeks of regular use and also with intermittent use.

 

 

 

Edited March 6, 2023 by Karma
Name update

[Mcat]

Thanks ever, so Gridley, I really appreciate your responses. This can feel isolating, and I feel very alone with it all and have zero faith in medical advice. As per your suggestion, I'll stick to the 7.5 for a month and continue for 2 more weeks on compounding capsules. My big concerns at this stage are whether I will settle into sleeping okay again on the 7.5 (hopefully I will, given the past history of success on that dosage) and whether the jerks will be a significant enough problem again to interfere with sleep. One thing I have learned (the hard way) through all this is that while I now totally believe the hypnic jerks are caused by the Mirt, they are definitely exacerbated by stress/anxiety, so doing all the good things to keep myself calm and trying not to stress about them (hard, as they are so awful and can be so disruptive) will be critical. And then how to manage the original pre-Mirt insomnia once I get down on the very low doses (3.75 has also worked for me for sleep quite often in the past, but less reliably/solidly); below that, I expect I'll have issues, but I'll cross that bridge when I come to it. For now, the main thing is to stabilise, as you say, and to avoid doing any more damage to my system, as I'm pretty sure I'm already kindled. And I hear you re Temazapm; I've been around the block with benzos in the past, and I know how problematic they can be, and Lord knows, I don't need any more drug problems. 

[Altostrata]

Hello, @Mcat

 

Welcome to the underground population of millions who have had difficulty coming off psychiatric drugs!

 

On 3/4/2023 at 1:02 PM, Mcat said:

My big concerns at this stage are whether I will settle into sleeping okay again on the 7.5 (hopefully I will, given the past history of success on that dosage) and whether the jerks will be a significant enough problem again to interfere with sleep.

 

Hypnic jerks were the adverse effect you had before from 7.5mg mirtazapine?

 

This type of reaction sometimes is because the drug is causing you to sleep too deeply, which causes your nervous system to alert -- it's afraid you're going unconscious. It may help you to play very soft music, such as meditation music, on an endless loop, all night long, or a brown noise generator. Some people use a fan that's not too noisy. The sound will reassure your nervous system and perhaps calm the alerting reaction.

Edited March 6, 2023 by Karma
Name update

[Mcat]

Hi Altostrata, thanks for responding - pretty desperate for support tbh. "This type of reaction sometimes is because the drug is causing you to sleep too deeply, which causes your nervous system to alert -- it's afraid you're going unconscious" - this rings true. The jerks kicked in about 3 months into 7.5 during a time of extreme work-related stress. It felt like my stress levels, and the sleep-promoting aspect of the drug was clashing and that I was locked into fight or flight hyper-alertness (essentially, my amygdala and CNS fighting the drug). It then got worse as I gradually realised it was a problem and began freaking out I had a brain tumour, MS, Parkinson's etc., (it's VERY clear that the more stressed and anxious I am, the worse it gets, so I'm doing what I can re breathing, meditation etc, to keep myself calm, but it's an uphill battle). I now know it's the drug because after 6 weeks off it, they were starting to settle, but I was by then demented from a month of crazy-making savage insomnia and was scared of losing my job and ending up homeless, so wanted to believe this random psychiatrist I went to in desperation when she assured me they wouldn't have lasted as long as 5 weeks off the med if they were from the Mirt (I won't be going back to: her only other grand plan was to put me on Paroxetine and Seroquel, which I rejected). It's very clear from this and the FB group that her advice was rubbish. I probably did need to reinstate, given where I was, but I wish to God I could go back in time and recommence on 3.75 as that has been reasonably effective for me for sleep in the past, and who knows, it might have done the job without reactivating the jerks. But as we know, there's no going back, just trying to do as little further damage from where you are. I'm all ears for your thoughts. 

[Mcat]

PS: I already use a fan so have quite a bit of white noise in the bedroom. My usual insomnia pattern is that I can go to sleep okay, but wake up too early and can't go back (typically around 3 or 4am). Last night, I had trouble falling asleep, then did for maybe 4 hrs after I took 1/4 10mg Temazepam, but woke up at 4 and couldn't go back. Are there any other ways I can soothe my system? One slightly positive development in this cluster**** is that I'm no longer stressing that it's something sinister BUT I am still anxious about it affecting my ability to sleep, which is going to be a challenge to manage. Last night, I was too anxious to sleep - not sure if it was Mirt WD already, having had a few nights on a higher dose, but I did start drifting off after a time and then ZAP, woken by a jerk. That's when I took the Z pill. I'd also had a very unsettling day realising the jerks were back and discovering these groups and reading up and realising what a pickle I'm in and what a long road it's going to be out. 

[Altostrata]

On 3/4/2023 at 5:25 PM, Mcat said:

My usual insomnia pattern is that I can go to sleep okay, but wake up too early and can't go back (typically around 3 or 4am).

 

Waking up too early is very common when destabilized by withdrawal. Blackout shades and a sleep mask can help. See

 

What is the sleep cycle?

 

Waking with panic or anxiety -- managing the morning cortisol spike

 

Tips to help sleep -- so many of us have that awful withdrawal insomnia

 

Path to Better Sleep FREE online for everyone from the US Veterans Administration

 

Music for self-care: Calms hyperalertness, anxiety, aids relaxation and sleep

 

White noise devices for sleep

 

Melatonin for sleep: Many people find it helpful

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

 

Strange sensations while falling asleep -- surges, zaps, jerks

 

Hypnic / hypnagogic jerks when falling asleep

Edited March 6, 2023 by Karma
Name update

[Mcat]

Hi again, already have an eye mask - it's all internal; big cortisol spikes, I expect. Thanks so much for these links. There's no drug deets on your profile, and I'm curious about your story if you care to share. Anyway, I'm super grateful for your responses (and I like San Fran - I had heard for years before I went there how like Sydney it is and it's true (except more hilly and way weird weather ). 

[Utek]

21 hours ago, Mcat said:

and I'm curious about your story if you care to share.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970174/

 

I'm extremely new at all this, but I have found keeping things very stable is very important.  I tried going from 15mg to 10mg and had 100% insominia.  I have since tapered from 15mg to 9.4mg doing the 10% a month no harm taper, and I can still sleep.  Study the information on this website.  The people here are fantastic.  Good luck to you.

Edited March 6, 2023 by Karma
Name update

[Mcat]

Urgent situation:  Mirt versus Lorazepam

 

I have a tricky situation where I reinstated Mirt 11 days ago after coming off too fast and experiencing insomnia over 4 weeks off the Mirt, which left me a wreck after a month (see signature for full story). I came off because hypnic jerks developed (either Mirt induced, related to ceasing intermittent Valium that I didn't think I was using regularly enough to WD from or a combo), and when I reinstated, I got internal shaking/tremors, and within a couple of days, the jerks came back.

 

Because I went up and down for 5 days between 7.5 and 15 - torn between following my gut instinct and following psych's advice to work up to 15, I now have insomnia on 7.5, which used to be solid for sleep for me.

 

I took a bit of Temazepam the last 2 nights, hoping it would help with sleep, but it only helped a bit as the dose was very small. I am now a convert to 10% tapering,

 

BUT the thought of spending many months coming down off a drug that's giving me the shakes/tremors/jerks and not even helping me sleep (the reason I went on it) makes me think maybe I should jump off now before it gets more of a hold (the 4 weeks on mark seems significant from what I've read) and cover with Lorazepam (longer acting/less problematic WD than Temazepam by the sound of it) for 4-6 weeks to stabilise and then do a 10% taper of that.

 

I have to make a decision one way or another soon as every day counts, and I can't afford to get as exhausted and messed up in the head as I did during that month of bad insomnia, where I thought I was going to lose my job and end up homeless. Another significant factor is that Temazepam seems to soothe the shakes and jerks, which bodes well for another benzo like Lorazepam (which I've not ever tried to date). I know no one can tell me what to do, but I would really appreciate some responses from people who know much more about all this than I do. 

Edited March 7, 2023 by manymoretodays
Title added, spacing for readability, and merged from tapering forum

[Mcat]

PS: I'd also love to hear from anyone who has done a 10% taper of Lorazepam how it went. 

[manymoretodays]

Hey there.  I've moved your topic from tapering back here, so moderators and members can see your information in context.

I'll go ahead and ask someone from staff to take a look at ASAP too.

 

So sorry for your difficulties Mcat.  Sending the best through the airwaves.

[Mcat]

Thanks ever so @manymoretodays. Being new and in a bit of a mess, I realised too late that I'd posted in the wrong location, but when I went to the post to delete it, I couldn't see how. I'll be sure to post in my topic henceforth (and I'll go in now and add an update as the post you move is now slightly redundant). I appreciate the kind words. 

[Mcat]

UPDATE: I'm no longer considering switching from Mirt to sleeper benzo, having done some more research on the latter. Also, my panic following the return of the jerks has subsided a bit, and I'm pleased to say that while they continue and they are God awful, they aren't causing too much disruption atm. I think that's mostly because I am working overtime doing breathing and mindfulness exercises to calm my nervous system (it's now established that they, for me, both side effect and WD symptom of Mirt, but also stress-related so they get worse the more anxious I am). I've now had 4 nights back on 7.5, and sleep still hasn't settled back to solid/reliable, but I'm coping a bit better with that due to doing lots of self-care. I have a big, demanding job (e.g., have to work till 7 today having started at 8.30 on about 5 hrs broken sleep max). I really hope it does settle again, so I will do my best to keep things calm and steady. One problem is that here in Aust, you can't buy a 7.5 pill, only a 15mg, so I have to split it, and hard as I try to do it well, there are always slight variables re sizing. I didn't notice any issues with that before I came off too fast in Jan, but I may be more sensitive to that now, which might explain why last night's sleep was much worse than the night before. If the sleep settles some and the jerks stay manageable, I feel confident I can stabilise on this dose before moving to a compounding chemist mediated 10% or less taper. 

[manymoretodays]

Yay you!!!  I'll take you out of the staff que then.

And encourage you to find some of the other mirtazapine taperers to help beyond what we have in that topic with your remaining taper.

Put mirtazapine in the search box in Intros and you may find some.

 

Yay again!

[Altostrata]

On 3/5/2023 at 4:46 PM, Mcat said:

Because I went up and down for 5 days between 7.5 and 15 - torn between following my gut instinct and following psych's advice to work up to 15, I now have insomnia on 7.5, which used to be solid for sleep for me.

 

These 5 days occurred at the end of February, correct?

 

It's now only a week later. Stabilizing after a period of inconsistent dosing can take weeks. Improvement will be slow and gradual.

 

Suggest you stop attempting to adjust your drugs, keep a consistent daily drug schedule, and be patient, allow your system to settle down.

 

Please let us know when you're ready to taper.

 

[Mcat]

It’s actually only been 4 nights since I stopped sliding up and down, so it’s very heartening to hear this feedback as it gives me hope it will settle if I just stay calm and keep things as settled as possible. I will stay on the 7.5 for sure till I’m good and stable but I wish I could get a more accurate dose each night as I have to split a 15 pill and they are never perfect halves. I really want to stabilise and start tapering when the time is right. Thanks for your perspective. 

[Hibari]

On 3/7/2023 at 11:51 PM, Mcat said:

It’s actually only been 4 nights since I stopped sliding up and down, so it’s very heartening to hear this feedback as it gives me hope it will settle if I just stay calm and keep things as settled as possible. I will stay on the 7.5 for sure till I’m good and stable but I wish I could get a more accurate dose each night as I have to split a 15 pill and they are never perfect halves. I really want to stabilise and start tapering when the time is right. Thanks for your perspective. 

Hi @Mcat

 

I wanted to say hello as I am tapering Mirt as well for the second time.  

 

Are you able to order a scale so that you can weigh your pill? It will help your have a more accurate dose when you break it in half.  

 

You can find information about how to use a scale in the tapering section on the site. 

 

There are a handful of people tapering Mirt and we are all at different doses and using different methods to taper. However, we all are tapering in a steady way in order to get off.  You can too when you are ready. 

 

Hibari 

 

[Mcat]

Hi, Thanks for responding, Hibari. I've found a way to get a bit of a more accurate split, but as it looks like I'm stabilising (two solid sleeps), so I'm hoping to be able to start tapering once I've got a month of stability under belt. Is there another thread where Mirt people gather under another name? I did a search, but hardly any threads apart from this show up?

[Hibari]

@Mcat

 

Hi, glad you are stabilizing on your sleep that makes all the difference.

 

Sounds like you have a plan for tapering and that's good.

 

No, we don't have a general Mirt category that we gather under. If you go to introductions, click on topic and the type in Mirtazapine, a bunch of threads should come up. 

You can then post on other people's threads. 

 

Hibari 

 

[Faure]

I am very successfully tapering mirtazepine. My topic is here. Happy to answer questions, especially about making your own pills to be sure of consistent dosing ☺️ 

[hopeful1987]

Hey Mcat, I'm also tapering mirtazipine after being put on it for an acute spell of insomnia. Like you, I'm trying to stabilize after adjusting dosages. I hopped off at 3.75mg (approximately) per doc instructions and got 2 sleepless nights back to back. I've been back on the pill 4 nights now, with 2 nights being solid and 2 being poor. Last night I only got an hour, maybe. So, I know a bit of what you're going through. My insomnia is primarily sleep onset, which is very tough to deal with. I feel like there's a certain sleep window and if I don't fall asleep in the window then I'll be up all night. Sometimes that's happened and sometimes it hasn't. But that's where things are with me. If you need encouragement feel free to reach out since we're both pretty much in the same place.

[Mcat]

Hi @Faure and @hopeful1987 good to hear from other Mirtzers (just made that up; kind of like it). The chemical WD insomnia is hands down the worst thing for me. Everything else I could live with and weather, but not that. Never known insomnia like it. Just so fierce. And then, because your WD anxiety is up on top of your original Anxiety Disorder (in my case, anyway), you're super ripe for sleep anxiety, which is its own world of hell, and the combination of the chemical insomnia and the sleep anxiety is untouchable. I'm so grateful to be stabilising - 3 good 8-8.5 sleeps in a row, nervous system no longer shaking in my body, and even the hypnic jerks, the Mirt side effect that led me to come off, is much better at about 5% last night down from 90% intensity when I started my too-fast-ill-informed wean and jumped off mid-Jan (but I credit certain anxiety reduction practices I'm doing religiously with that improvement, not the drug, which sets me up for it). So, just hanging here for a month, but pondering the options re tapering when the time comes. I was thinking of buying a digital scale, as has been suggested here for the initial jumps and then moving to a compounding chemist (expensive) for when I get to the approx 3mg pointy end for more accuracy, but I think it would mess with my head trying to get the dose right on a scale and then what would be options be if the dose is off? Only way I could see it working is to crush the pills into powder form, try to get the dose right that way, and then ingest in a smoothy or something. I'll check out your thread Faure - keen to see how others are going about it. I know for sure the liquid business is beyond me. I am THE WORST at maths and that kind of thing triggers anxiety for me. Hopeful, I hear you. Jumping off 3.75 in Jan is what did me in too. You were smart to reinstate so fast and to reinstate low. I now wish I'd tried 3.75 first. Hold tight where you are. I reckon you'll stabilise soon. I was very freaked out, having insomnia on 7.5, which had always been rock solid for me for sleep. It really rattled me, but in the end, I only had a few bad nights (assuming I now hold to the current pattern on this dose). 

[Mcat]

PS: @Faure I've checked out your thread - great you're tracking so well. I couldn't find a coherent explanation of the Brassmonkey slide method, though. Are you able to enlighten me? It sounds like it's really worked for you. But it also sounds like it does depend on being able to liquefy and control the dosage yourself (which, as I said, I honestly don't think I could master). I worry that going down <10% drops will mean it will take a thousand years to taper, but also, if I'm using a compounding chemist, that would be way expensive, changing doses every couple of weeks. I've got a few weeks to decide on a plan, but I really need to get a good strategy in place before I take any further action as I can't risk major destabilisation given I have a big, demanding, public-facing job, and I don't think I could take it after a very stressful 5 years with the last year being a cluster**** of major life stresses and AD WD - I've only just realised that I was actually in WD for the first half of 2022 after I came off St John's Wort suddenly, went on Mirt, was taken off Mirt by GP, put on Endep, then back onto Mirt (I'd better go add all this into my signature). 

[hopeful1987]

Yes, the insomnia is brutal. Thankfully its my own WD symptom, but it's a beast all by itself. One thing that helps me is to remember that even on a sleepless night i do well the next day. Im writing this to you after a nearly sleepless night and ive functioned pretty well today. So, allow that to ease your anxiety. Not easy, but it helps.

 

I bought a scale just to make my 3.75mg doses more accurate. I was quartering a 15mg with a pill cutter and razor blade and it looked fairly accurate to the naked eye, but i weighed my quarters and they were all different. So now i use a scale and a nail file to shave them so they're all reading 3.7mg on the scale. Prior to jumping off I was stable on my inaccurate doses, so i figure this is even more accurate and will hopefully help me stabilize sooner. So, a scale is useful, but if youre stabilizing on the pill, Id honestly go the liquid route for the taper since we'll all have to do that in the end anyway. After I stabilize on 3.75 i plan to transfer to the liquid. Doing your own liquid is actually easy, but a chemist obviously saves you all the trouble for a cost. 

[Mcat]

You're right - I was surprised at how well I functioned overall after those few sleepless nights last week, and what I noticed was the difference staying calm through the night made. I got a bit hysterical with fatigue and sleep anxiety during the big WD before I went back on, and that potential was there last week, but because I'm working overtime at soothing myself and doing all the good things to manage my anxiety, I did much better the next day. That said, you lose it when they start to rack up back to back over days/weeks. I'll have a look at digital scales. I'm sure I'm not getting as accurate dose as would be ideal. 

[Mcat]

@Altostrata I saw you mention NOW protein powder as an insomnia aid on some thread, and I expect to be dealing with it to some degree when I start tapering, but they have two similar products. One is noted as 'protein powder concentrate' and the other as 'protein isolate' - do you know if both are equally good, or is one better?

[Mcat]

@hopeful1987 I've been researching digital scales, but they mostly seem to weigh in g rather than mg, and I came across this caution: 'Milligram scales under $1000 cannot accurately weigh out doses below at least 50mg and are highly inaccurate under 10-15mg, for more accurate readability add the included calibration weight to the scale without taring before you add a 10+ mg dose.' This is what I mean by it being beyond me. I do not understand numbers, and I don't think it's something I can learn. I'm kind of dyslexic, but with numbers instead of language. I think I'll have to live with the less than 100% accurate 7.5 halves (given I can't get 7.5 pills where I live) and then compound chemist, though that's going to kill me financially. 

[hopeful1987]

Yeah, if youre stabilizing on your cuts then i wouldnt do anything different, but that's just me.  I got the scale because 3.75 cuts are harder to eyeball than 7.5. I also bought empty pill capsules on amazon. So, i weigh the capsule by itself, which is 95-98mg, then i put the quarter pill inside it and either shave the pill or add crushed pill powder until the total is right. So, im not measuring anything below 100mg. 

[Mcat]

See, even that numerical explanation broke my brain. I'd love to taper from 7.5 down to 2 or 3mg or so (when the time is right to start doing that) using digital scales and then move to compounding as it would save me a packet, but I don't trust myself to have a handle on the figures and get it right, and after what I'm being through I'm very risk-averse. 

[Faure]

Hi, I thought this might help:

 

I make up 7 tablets at a time, so when you start you’ll need to pulverise all 7 and then weigh out 7 identical amounts. Much better this way as it’s all done in about 15 mins (when you get the hang of it) just once a week, rather than daily. I also like to believe doing it all in one go gives the best chance of getting identical weights with the calibration etc. These days I use just over 2 pills a week, so I usually pulverise 3.  Here is how I do it: 

 

Step 1, only necessary the very first time: weigh three whole pills and divide the total weight by 3 to get the average weight per pill.

 

Step 2 calibrate the scales

 

Step 3 grind 7 pills, I put the powder into an egg cup and stir it with a toothpick, including the outer layer of the pills (my outer layer is yellow and the powder is white). 
 

Step 4, open a capsule. Using a teaspoon scoop up some powder and using a toothpick knock it into the measuring tray till you get the right weight. I take off excess powder with the tweezers that come with the scale. 
 

Step 5 tip the powder into a folded small piece of paper and use this to transfer the powder into the capsule. Don’t worry about microscopic bits not making it into the capsule. 
 

Step 6 repeat till 7 pills are complete and store spare powder in a separate capsule for next time.  I then use this powder first in my next session. Be sure to keep pills in the dark. 
 

***Nb while your active ingredient weighs 15mg, the pills themselves weigh about 150mg because of fillers. Fortunately it’s a factor of 10 bigger so even I could manage the difference although I didn’t understand till a friend explained 😂😂. On the taperoff document I convert all the numbers so they match the scale readout. E.g your first reduction might be from 152mg to 148 and on the scales this will read 0.152 and 0.148.

 

I bought myself a nice pill grinder as I’ll be doing this a few years.  My equipment:

 

Scale 

Pill crusher

Size 0 capsules

 
I have had absolutely no problems doing this method. It seems daunting but I got the hang of it in a couple of weeks. You just have to be patient getting the right number on the scales.

 

I also had no idea how to do the liquid but a friend (mathematician) made me a super spreadsheet and I now feel ok about making a liquid. Maybe I (he) can provide a version of the sheet for others to use in time. I’ll ask. 

[Faure]

Here is info in the BrassMonkey slide. I highly recommend this, especially if you’re already anxious about tapering and also must stay well for work.  I had some WD symptoms in the early days, especially with getting to sleep but I kept going with work all the time. I found for a while I’d feel scared for no reason the day after a drop but was able to recognise WD, know it would pass and it did. I think I have had one (tapering related) day off in the 18 months I’ve been tapering. 

The best thing I did, without knowing it at the time, was to start meditating about 18 months before tapering (I started because of the overwhelm of the pandemic). This has  *really* helped with staying calm, calming myself and accepting symptoms. I try to do it most days. So do start that now! 

 

Yes, it takes YEARS but it’s the only way to get off and be sure to stay well. I can say the time goes fast and I have always gradually felt better and better so that really helps keep motivated and stick to the plan. There are times when I want to hurry up but I always ask here and others keep me on track.  

[Faure]

Regarding:

 

Quote

Milligram scales under $1000 cannot accurately weigh out doses below at least 50mg and are highly inaccurate under 10-15mg,

the good news here is a whole pill weighs about 150mg because of filler. So no need to worry about that right now ☺️