Franco12: The supposedly endless eclipse of discontinuation.

[Franco12]

Good morning, my name is Franco. I have been avidly reading information from the forum on discontinuing antidepressants for months (specifically, I am also undertaking the enormous challenge of discontinuing and deprescribing a drug with psychotropic action, Sertraline). First of all, my native language is not English, as I am a Spanish speaker. I hope you can understand the imperfections in the composition (I will undoubtedly have help from translation programs, plus some rudimentary knowledge of English grammar).

 

I started taking sertraline in August 2023 (to this day with total regret, although presumably it is a common denominator in the sample of people "treated" with selective serotonin reuptake inhibitors, and I would not be surprised at all that this feeling of restlessness would also extend to people being treated with drugs from other pharmacotherapeutic configurations).

 

For some time now I have completely removed myself from arguments regarding "diagnosis", since the arbitrariness governing diagnosis in the territory of psychiatry is so vast that talking about it is more ludic-comical than rational. I will limit myself to testifying to my behavior during each of the reductions, and whether they are compatible (or not) with a slow-taper paradigm, by virtue of reducing the intensity of the discontinuation syndrome.

 

I wanted to say thank you to those people willing to read and provide me with advice on the tapering program. Perhaps it is also pertinent to thank all the administrators of this community, who open the door to the formation of an instruction space for those people who have had the misfortune of facing a discontinuation process.

My reduction strategy, so far (since I am at 50% of the volume originally prescribed to me) is to divide the tablet into eight units, and remove ⅛ of a unit every 21 days (say, remove ⅛ of a tablet, create a space of stabilization of three weeks, and then proceed to withdraw ⅛ of the tablet again). In this way, I have already removed 4/8 of a tablet in total. Is it a fast or slow rate of reduction?

 

The originally prescribed dose was 50 milligrams of sertraline, so I am currently taking 25 milligrams per day.

 

It is also pertinent to note that I asked about seven psychiatric professionals (seven consultations with different professionals) about a liquid formulation, but presumably they did not consider it necessary, or they were not familiar with a liquid prescription, or there is simply no liquid form for that medication in my country. Will there be any possibility of manually making a liquid formulation of a pharmaceutical product that is sold in tablet form?

 

 

All the best.

 

[Erimus]

Hello Franco, and welcome to Surviving Antidepressants. We are a peer support forum to assist in tapering off psychiatric drugs safely, or recovering from psychiatric drug withdrawal. Hopefully the translate function in your web browser allows you to sufficiently understand the information provided here.

 

Your first task is to create a drug signature, with the following:

 

• All current medication you take, the dose you take, when you started the drug, and when you made dose changes
• All current supplements you take
• An accurate history of recent drugs, taken in the last 12-24 months
• Dates for recent should be written as 7 Oct 2023, or Oct 7 2023, or early Oct 2023, or mid Oct 2023
• A history of drugs taken 24 months ago and beyond - if applicable
• Dates for historical drugs can simply be listed as start and stop years
• Please do not use 07/10/23 // 10/07/23 as this is intepreted differently around the world

 

• Please leave out symptoms and diagnoses. See my signature for example of clear and concise information.

 

• Click this link to edit your signature: Edit your signature here.

 

 

This topic is for anything relating to you, and any questions you have. Please do not start another topic.

 

We recommend tapering by no more than 10% of your CURRENT dose each month, to limit withdrawal symptoms. E.g. 10mg --> 9mg --> 8.1mg --> 7.29mg

 

All the answers you are looking for regarding tapering and antidepressant withdrawal are on this site. Please search around and continue to read as much as you can manage. Use the site search function to search for specific words or phrases, such as drugs or symptoms.

 

Here are a few of the most useful links:

 

Important topics in the Tapering forum and FAQ

 

Micro tapering

 

Why taper by 10% of my dosage?

 

Taking multiple psych drugs? Which drug to taper first?

 

How to make a liquid from tablets or capsules

 

Using a scale to weigh and measure doses

 

We only recommend two supplements. Omega 3 Fish Oil and Magnesium. Both should be introduced separately and increased slowly.

 

Regards

Erimus

[Erimus]

9 hours ago, Franco12 said:

My reduction strategy, so far (since I am at 50% of the volume originally prescribed to me) is to divide the tablet into eight units, and remove ⅛ of a unit every 21 days (say, remove ⅛ of a tablet, create a space of stabilization of three weeks, and then proceed to withdraw ⅛ of the tablet again). In this way, I have already removed 4/8 of a tablet in total. Is it a fast or slow rate of reduction?

We recommend no more than 10% of your current dose per month. So from 25mg, you would drop down to 22.5mg and wait a month, then down to 20.25mg.

 

This is not possible by simply cutting the tablets into 1/2s, 1/4s and 1/8s. So what we have to do is crush and weigh them, or create our own liquid suspension.

 

Please read the following topics for more on this:

 

Using a scale to weigh and measure doses

 

How to make a liquid from tablets or capsules

 

Making your own liquid suspension can be as simple as dissolving your 50mg tablet in 200ml of water, which would give you 0.25mg/ml. In order to make your first reduction from 25mg to 22.5mg, you would use a syringe to draw up 90ml of the solution.

[Franco12]

Good morning, Erimus,  thank you very much for the information and for your availability to respond. I mistakenly thought that I would need more complex instruments to prepare a liquid form of my medication. Had I been aware of the simplicity of the mechanism in advance, at the beginning of the reduction I would have started directly making home made liquid preparations. It's a shame not to have found that information earlier.

 

An additional question.

 

I have recently experienced higher stress levels, similar to symptoms from other reductions I have had previously in my history (specifically, reduction of Paxil in 2021). Taking into consideration the errors that I had so far in the reduction: instead of reducing by ten percent reduce by ⅛, instead of liquid form asymmetric partitioning of the solid, instead of waiting four to six weeks waiting merely three weeks, etc. . What would you recommend? I don't know if it would be prudent to restore the original dose (50 milligrams), and from there begin a more "responsible" reduction, or perhaps try with intermediate doses (higher than the current 25 milligrams), for example, 30 milligrams, or 40 milligrams, stabilize there, and then reduce. In other words, what is the escalation protocol like if a person underwent an erroneous taper, or is experiencing escalating discontinuation syndrome?

 

My concern particularly arises from the fact that during the first half of the reduction (transition from 50 milligrams to 30-25 milligrams) I was not familiar with the ten percent rule, and therefore, the reduction methodology was of low quality, with errors inappropriate for a planned reduction.

 

All the best

On 4/4/2024 at 8:22 PM, Erimus said:

We recommend no more than 10% of your current dose per month. So from 25mg, you would drop down to 22.5mg and wait a month, then down to 20.25mg.

 

This is not possible by simply cutting the tablets into 1/2s, 1/4s and 1/8s. So what we have to do is crush and weigh them, or create our own liquid suspension.

 

Please read the following topics for more on this:

 

Using a scale to weigh and measure doses

 

How to make a liquid from tablets or capsules

 

Making your own liquid suspension can be as simple as dissolving your 50mg tablet in 200ml of water, which would give you 0.25mg/ml. In order to make your first reduction from 25mg to 22.5mg, you would use a syringe to draw up 90ml of the solution.

 

[Franco12]

On 4/4/2024 at 8:22 PM, Erimus said:

We recommend no more than 10% of your current dose per month. So from 25mg, you would drop down to 22.5mg and wait a month, then down to 20.25mg.

 

This is not possible by simply cutting the tablets into 1/2s, 1/4s and 1/8s. So what we have to do is crush and weigh them, or create our own liquid suspension.

 

Please read the following topics for more on this:

 

Using a scale to weigh and measure doses

 

How to make a liquid from tablets or capsules

 

Making your own liquid suspension can be as simple as dissolving your 50mg tablet in 200ml of water, which would give you 0.25mg/ml. In order to make your first reduction from 25mg to 22.5mg, you would use a syringe to draw up 90ml of the solution.

For clarification, this "irresponsibility" in terms of reduction extends between 50 milligrams and 31 milligrams, since the subsequent reductions, starting at 31.25 milligrams, were with liquid preparation at home, a maximum percentage reduction of ten percent, and about four weeks of waiting before making a new transition.

 

Another element that I wanted to point out is that this escalation of symptoms, previously mentioned, occurred in the last two or three days. Even the week before I felt extraordinarily well, however, at the beginning of this week I noticed an increase in symptoms. Would it be advisable to wait more days - weeks and evaluate before taking action to increase medication?

 

My current dose is 28,12 milligrams (the liquid suspension is 200 mililiters, and I take 112 milliliter)

 

All the best.

 

 

[Franco12]

On 4/4/2024 at 8:22 PM, Erimus said:

We recommend no more than 10% of your current dose per month. So from 25mg, you would drop down to 22.5mg and wait a month, then down to 20.25mg.

 

This is not possible by simply cutting the tablets into 1/2s, 1/4s and 1/8s. So what we have to do is crush and weigh them, or create our own liquid suspension.

 

Please read the following topics for more on this:

 

Using a scale to weigh and measure doses

 

How to make a liquid from tablets or capsules

 

Making your own liquid suspension can be as simple as dissolving your 50mg tablet in 200ml of water, which would give you 0.25mg/ml. In order to make your first reduction from 25mg to 22.5mg, you would use a syringe to draw up 90ml of the solution.

 

Previously I said that in each transition-reduction by ⅛ tablet I had waited about three weeks. However, after examining the reduction schedule, I noticed that this information was not entirely accurate. I will directly send the information on my reduction schedule, to record the date and volume of reduction, current dose, etc.

 

On February 11, the dose was 50 milligrams, the dose that had originally been indicated to me. On February 12, the first instance of reduction arrived.

 

February 12. Transition from sertraline 50 milligrams to 43.75 milligrams (methodology, reduction by dividing the tablet into eight parts, and I removed one eighth part. Without weighing, without scale)

Eight days of waiting (.....)

 

February 20th. Transition from sertraline 43.75 milligrams to 37.5 milligrams (methodology, reduction by dividing the tablet into eight parts, and I removed another eighth part. Without weighing, without scale)

24 days waiting.

 

March, 15th. Transition from 37.5 milligrams to 31.25 milligrams. (methodology, reduction by dividing the tablet into eight parts, and I removed another eighth part. Without weighing, without scale)

21 days of waiting.

 

April 4. Discovery of liquid preparation at home.

 

 

5th of April. Transition from 31.25 milligrams to 28.125 milligrams (first ten percent reduction, with liquid preparation)

 

My current dose is 28.12 milligrams (the liquid suspension is 200 milliliters, and I take 112 milliliters of the preparation).

 

All the best

 

 

 

 

 

 

 

[Franco12]

On 4/4/2024 at 8:22 PM, Erimus said:

We recommend no more than 10% of your current dose per month. So from 25mg, you would drop down to 22.5mg and wait a month, then down to 20.25mg.

 

This is not possible by simply cutting the tablets into 1/2s, 1/4s and 1/8s. So what we have to do is crush and weigh them, or create our own liquid suspension.

 

Please read the following topics for more on this:

 

Using a scale to weigh and measure doses

 

How to make a liquid from tablets or capsules

 

Making your own liquid suspension can be as simple as dissolving your 50mg tablet in 200ml of water, which would give you 0.25mg/ml. In order to make your first reduction from 25mg to 22.5mg, you would use a syringe to draw up 90ml of the solution.

The increase in symptoms that I particularly link, presumably to a discontinuation syndrome, occurred on Sunday, April 28. I certainly do not know if they are due to discontinuation, since I had a complicated family circumstance, and in similar circumstances (for example, in the month of January) at the maximum dose of medication, the symptomatic reaction was identical to the current one, simply that now I am on reduction of medication, and I don't know whether to attribute this accentuation of symptoms to the reduction process, or merely to issues of another order, such as a domestic or work complication, etc.

[Erimus]

1 hour ago, Franco12 said:

Another element that I wanted to point out is that this escalation of symptoms, previously mentioned, occurred in the last two or three days. Even the week before I felt extraordinarily well, however, at the beginning of this week I noticed an increase in symptoms. Would it be advisable to wait more days - weeks and evaluate before taking action to increase medication?

I would hold on your current dose of 28.12mg for a few weeks. Rather than increasing, it is often better to see if the mind and body can work things out itself. I suspect after a short hold that things will improve.

 

1 hour ago, Franco12 said:

The increase in symptoms that I particularly link, presumably to a discontinuation syndrome, occurred on Sunday, April 28. I certainly do not know if they are due to discontinuation, since I had a complicated family circumstance, and in similar circumstances (for example, in the month of January) at the maximum dose of medication, the symptomatic reaction was identical to the current one, simply that now I am on reduction of medication, and I don't know whether to attribute this accentuation of symptoms to the reduction process, or merely to issues of another order, such as a domestic or work complication, etc.

It is likely a combination of both. Stress is inevitable in life, but it can exacerbate symptoms for those of us in withdrawal from psychiatric drugs. Smaller reductions will be the key going forward. The priority is maintaining functionality whilst tapering, and the way to do this is drops of 5% or less. You may find that you can do these every few days, you just need to monitor how your symptoms change after each drop. A diary is a good way to track this.

 

18 hours ago, Franco12 said:

My concern particularly arises from the fact that during the first half of the reduction (transition from 50 milligrams to 30-25 milligrams) I was not familiar with the ten percent rule, and therefore, the reduction methodology was of low quality, with errors inappropriate for a planned reduction.

It is not your fault, none of us were familiar with these tapering rules until we'd already made mistakes.

 

Best wishes

Erimus

Edited yesterday at 02:31 PM by Erimus

[Franco12]

5 hours ago, Erimus said:

I would hold on your current dose of 28.12mg for a few weeks. Rather than increasing, it is often better to see if the mind and body can work things out itself. I suspect after a short hold that things will improve.

 

It is likely a combination of both. Stress is inevitable in life, but it can exacerbate symptoms for those of us in withdrawal from psychiatric drugs. Smaller reductions will be the key going forward. The priority is maintaining functionality whilst tapering, and the way to do this is drops of 5% or less. You may find that you can do these every few days, you just need to monitor how your symptoms change after each drop. A diary is a good way to track this.

 

It is not your fault, none of us were familiar with these tapering rules until we'd already made mistakes.

 

Best wishes

Erimus

 

I also thought that perhaps by allowing a few days-weeks to pass, the symptomatic situation could probably regularize naturally. It happened on previous occasions, so I'm optimistic in that sense. 

I will maintain the current dosage (28, 12 milligrams) for minimally three - four weeks before making a decision.

 

For the moment, just adding a preventive question. If after a few weeks the situation does not improve (or worse, it escalates even more), is there a forum within the site where I can find information regarding escalation after an improper reduction? (improper reduction between 50 milligrams and 31.25 milligrams, on many levels, wrong in terms of time, procedure, percentage, etc.) It's probably best to keep myself informed, rather than intuitively decide in the middle of the storm (let's say, if after a few weeks the situation is still delicate)

 

Just as there are some generic protocol behaviors in reduction, perhaps symmetrically there are recommendations to increase medication after negligent reduction if things are not going well (The situation will probably resolve spontaneously after a few weeks, but I also want to be prepared for the worst-case scenario.)

 

Thank you very much for your contribution, Erimus. 🙏

 

 

[Erimus]

42 minutes ago, Franco12 said:

 

I also thought that perhaps by allowing a few days-weeks to pass, the symptomatic situation could probably regularize naturally. It happened on previous occasions, so I'm optimistic in that sense. 

I will maintain the current dosage (28, 12 milligrams) for minimally three - four weeks before making a decision.

 

For the moment, just adding a preventive question. If after a few weeks the situation does not improve (or worse, it escalates even more), is there a forum within the site where I can find information regarding escalation after an improper reduction? (improper reduction between 50 milligrams and 31.25 milligrams, on many levels, wrong in terms of time, procedure, percentage, etc.) It's probably best to keep myself informed, rather than intuitively decide in the middle of the storm (let's say, if after a few weeks the situation is still delicate)

 

Just as there are some generic protocol behaviors in reduction, perhaps symmetrically there are recommendations to increase medication after negligent reduction if things are not going well (The situation will probably resolve spontaneously after a few weeks, but I also want to be prepared for the worst-case scenario.)

 

Thank you very much for your contribution, Erimus. 🙏

 

 

If you feel the need to increase it's best to adopt the same principles as decreasing. Don't increase by more than 10%, and wait a few weeks before changing again. Hopefully things resolve by staying on the same dose. Given you've been on the drug less than a year, I have hope that things will resolve with some time and patience.

 

Regards

Erimus