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 May 1 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

[Franco12]

 

Hello Erimus! Once again I find myself in the urgent situation of having to consult, due to a complication that recently emerged, and it is certainly generating enormously distressing uncertainty for me.

 

Unfortunately, in recent days (after a surgery performed on June 10, since the days and weeks before I felt mostly well) the symptoms have increased considerably, in terms of nervousness, loss of rest, nighttime awakenings, coordination, and primarily, difficulty concentrating. It is extremely difficult to maintain clarity in the analysis of the scenario, because I also had surgery with anesthesia general, and obviously anesthesia can also negatively affect recovery, but above all the discernment of whether the accentuation of symptoms is residual from the application of anesthetic substances, or is a product of the controlled reduction process of antidepressants.

 

The dilemma is the following. Due to the obvious increase in symptoms, I decided to increase medication (and later, perhaps in a few months, begin an even slower, even more parsimonious reduction). However, if indeed (let's say by hypothesis) the increase in symptoms is due to post-surgery stress + stress that subtly accompanies a process of medication reduction (and not a result of the application of anesthesia), and if I am indeed undergoing a episode of discontinuation syndrome (certainly the symptoms I have are similar to those I experienced when stopping other medications), what to do? How to increase medication to experience symptom relief?

 

Increasing excessively quickly (a psychiatrist suggested the possibility of restoring the dose of 50 milligrams with a transition of two or three days) is perhaps too violent a reinstatement, and rather than remedying the symptoms, it may perhaps raise more problems, and end up with a position even worse than today.

 

The other alternative would be a controlled increase, for example, by ten percent every four or six weeks, however, if my body is “experiencing 50 milligram discontinuation,” say, the dose I originally had, it will take months to reach that dose. dose, and I will be subjected to numerous weeks of high-intensity discontinuation symptoms. 

 

It seems like a ticking time bomb, and I have no knowledge of how exactly to defuse it. 

 

A slow escalation strategy has the benefit of not exposing me to a drastic change in medication, and it is generally benign to avoid drastic changes in milligrams of drug. However, it has the disadvantage that it would take months to reach a dose close to the original (50 milligrams of sertraline)

 

A rapid increase strategy has the benefit that it would quickly reach a dose close to the original, but perhaps increasing so abruptly could destabilize even more.

 

And as a complication of the above, it is absolutely impossible to discern if the accentuation of symptoms is a product of pre-operative and post-surgical stress, in addition to the influence of anesthetic products during surgery, or if the increase in symptoms is actually a product of the decrease. of medication between February -May of this year, or both.

 

By the way, the dose I am currently taking is 29 milligrams, about 116 milliliters of the 200 milliliters that the liquid preparation contains.

 

I hope I have explained myself correctly, I have some nervousness in recent days about making a bad decision, and that deeply rooted emotional component often prevents me from explaining myself clearly.

 

PD: Above all, any course of action would be useless if the exacerbation of symptoms is due to anesthesia and surgery, and post-surgery, it would simply be making figures in the air. 

 

I also thought that perhaps my body could correctly assimilate the gradual reduction of medication, but could not simultaneously withstand the discontinuation of medication and the post-surgery (as if initially I had a broken tire, and I could drive without problems, but with a second broken tire, problems arose)

 

For more information, the surgery was a septoplasty, on June 10, 2024. The difficulties began after the surgery, because the week before I felt noticeably well.

A hug, Erimus.
I would love to be able to give a gift to the people on the forum, for voluntarily helping people in crisis, like me, hahaha

[Erimus]

Hello again Franco, and I'm sorry to hear things have taken a turn for the worse. Surgery and general anaesthetic are a stress on the body and nervous system, for normal people this is not a major problem, but for those of us in withdrawal it can poke our already fragile nervous system.

 

Please read our topic on this here:

 

Given that it has only been 8 days since the surgery, I would not rush into an increase in dose right away, it may provoke your nervous system even further. Hold firm on 29mg for a few more weeks before reassessing.

 

Please could you also fill in your drug signature so myself and the other staff can quickly read your history.

 

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

[Franco12]

Hello Erimus!  Good weekend !

Next Monday will be exactly two weeks since the surgery. Would this be a reasonably prudent time to increase the medication dosage, or in these situations is it more reasonable to save a few extra weeks before pursuing any course of action? 

 

Symptomatically speaking, I improved slightly compared to the previous week (first week post-surgery), but I am still significantly worse than my pre-surgical level (moodically, cognitively, in terms of sleep regularity, lower concentration, etc.)

I basically thought of an outline for the next few weeks that could take the following form:

 

Monday, June 24, two weeks after surgery, increase six milligrams. Transition 29 milligrams to 35 milligrams.

 

Monday, July 1, again increase five milligrams. Stabilization at 40 milligrams 

 

I don't know if this medication amplification plan is too rapid, or if it is in compliance with the escalation standards. A psychiatrist instructed me to go straight up to 50 milligrams over a period of two or three days, but I certainly have a high degree of skepticism that following this instruction would result in a less difficult scenario. A few years ago a psychiatrist told me that it was perfectly safe to reduce 12 milligrams of paroxetine in a week or two, and afterward I was completely incapacitated for months.

 

Generally speaking, is it usually necessary to reach the original dose to experience mitigation of the discontinuation experience? My intention is to get back to 50 milligrams, and then begin a tediously slow reduction plan, in contrast to the February-March reductions, which I can now recognize, in retrospect, were excessively rapid. However, I read in the reinstatement section that some patients may develop hypersensitivity, that is, when reinstating the original dose, they will react adversely, leading to even greater destabilization. I don't know if it specifically refers to people who completely abandon medication, suddenly or quickly tapping, or it may also refer to patients who are still pharmacologically involved with X medication (the latter would be my case).

 

 

I also wanted to ask if I completed the medication signature correctly, or if I should make any modifications.

[Erimus]

I think if you were to hold on your current dose, things will improve significantly in the coming weeks. You have already mentioned vast improvements from the first week post-surgery.

 

If you are absolutely certain that you want to increase your dose, I would suggest following the same practice we use for decreasing. No more than 10%/month. So I wouldn't recommend increasing by more than 3mg per month.

 

Your signature is fine. I will clean it up a bit for visibility.

[Franco12]

Thanks for the prompt response, Erimus. I am optimistic that the situation may improve in a few weeks. Obviously it is still early for an evaluation of my post-surgical situation, and what direction I will follow in the coming weeks.

 

A significant concern regarding medication administration in the coming weeks (maintenance or escalation) is the following: I understand that the earlier the medication is reinstated from the onset of the intense discontinuation period, the more likely reinstatement may be effective in mitigating symptoms. It makes me a little nervous that by delaying the restitution of medication, I may later lose the window of opportunity for restitution. Obviously, reinstating medication would also simultaneously mean an enormous risk, as it could lead to more destabilization, and at the same time, I would then have to undergo a reduction of 50 milligrams and not 29 milligrams, which would mean perhaps one or two years more in tappering, therefore, more exposure to psychotropic drugs.

 

I always thought I was a person especially skilled at making decisions in moments of high tension, but psychopharmaceuticals in particular overwhelm my visualization capacity, hahaha.

 

I would say that the situation improved a little compared to the previous week. Still strongly symptomatic, but slightly more tolerable.

 

[Franco12]

One additional question, Erimus. If hypothetically in a couple of weeks the situation certainly normalizes, and my cognition and mood are at pre-surgical levels, is it possible that in two or three months I will have a significant symptomatic reactivation again? I am terrified of openly entering into a dynamic of improvement - relapse - improvement due to those too rapid reductions in February - March. I read somewhere on the forum that it is relatively common to experience discontinuation syndrome a few months after a rapid taper. Could it be possible that the discontinuation syndrome subsides, the patient stabilizes, and then reappears months later?

 

[Erimus]

On 6/22/2024 at 3:04 PM, Franco12 said:

One additional question, Erimus. If hypothetically in a couple of weeks the situation certainly normalizes, and my cognition and mood are at pre-surgical levels, is it possible that in two or three months I will have a significant symptomatic reactivation again? I am terrified of openly entering into a dynamic of improvement - relapse - improvement due to those too rapid reductions in February - March. I read somewhere on the forum that it is relatively common to experience discontinuation syndrome a few months after a rapid taper. Could it be possible that the discontinuation syndrome subsides, the patient stabilizes, and then reappears months later?

 

I think that is unlikely given both your time on medication (9 months), and the fact you are still taking 60% of your original dose.

Edited June 24 by Erimus

[Franco12]

Update on my evolution. On Monday, July 1, I had a ten percent increase in medication, a transition from 29 milligrams to 32 milligrams. Momentarily, the discontinuation syndrome does not seem to offer any ease. I would say I'm slightly better than about two weeks ago, but substantially worse than before surgery. Paradoxically, the surgery was precisely intended to reduce the complexity of discontinuation, since the calculation was basically that with better breathing I would have better rest, and deeper and more restorative rest would allow me to have significant advances in stabilization during tappering. What a mistake of innocence!!!!

 

The most uncomfortable symptoms since the exacerbation of the discontinuation syndrome due to the stress of anesthesia + operation + inappropriate reduction February - March are eminently in the order of cognition: less concentration, less naturalness in expressing myself, less capacity for memorization. In terms of physical symptoms, nervousness, restlessness, a constant but weak need to move. Honestly, the physical symptoms are irrelevant to me, the only circumstance that interests me is the evolution of cognition. If I have to remain forty more years with panic attacks or weak akathisia or migraines or gastric discomfort, I will give it little or no attention.    

 

Presumably the slight increase in medication (about ten additional milliliters) is with the intention of causing a decrease in the intensity of the discontinuation syndrome. 

Originally the plan was to remain on the same dose for a few more weeks, but after registering only a slight improvement three weeks after the operation , I thought it was the last opportunity to activate the reinstatement plan, since if more time elapses, the probability of mitigating the discontinuation syndrome with some type of increase will be increasingly elusive and distant.

 

In those terms, the current dose is 31.5 milligrams, about 126 milliliters of the 200 milliliter liquid suspension.

 

One question, Erimus. Strategically, the plan would be to make two or three increases (at intervals of three - four weeks in each increase). If after three or four increases I do not have any degree of remission of the discontinuation syndrome, then I will abandon the reinstatement plan (Let's say, I won't have any more raises), since without early signs of improvement I understand that the probability that successive increases will end in a mitigation of the discontinuation syndrome will be more remote. . In that sense, I would stabilize at a dose probably around 35-40 milligrams, and then start a 1.25% reduction plan for two-week intervals. 

 

Is it a rational medication administration plan? After the last episode of discontinuation syndrome, I have less confidence in my planning powers, and more fear of repeating unnecessary mistakes.

 

Honestly, I am more and more uncertain every day about whether I will ever feel like the old days again, without medication, without signs of discontinuation. I guess nostalgia is metastasizing inside me.

 

 

PD: Thanks for the suggestions, Erimus. 🌟 I am totally alienated in the administration of medication, because in the last few days I had a consultation with a psychiatrist, and again the same story: “I should have no problems in reducing medication, and the symptoms are the product of an episode of flowering of the underlying disease, and you should have no problem jumping from 30 milligrams to 50 milligrams over a period of two or three days." "Such a slow increase plan is an exaggeration on my part, typical of my inflammable mood and generalized anxiety."   

 

Obviously I cannot have any degree of trust in a psychiatrist, since it was first of all by entering a psychiatry office a few years ago (didn't I have anything more interesting to do that day?) that I arrived in such a complex position, and of so much vulnerability.

 

Better days will come, I hope. 💖

 

 

 

 

[Franco12]

También quería consultar. ¿Qué metodología puede brindar más precisión? Las dos alternativos que tengo disponibles al momento serían tomar la medicación sólida, fragmentar la pastilla, y pesar en términos de miligramos, o seguir con la metodología de forma líquida, preparación de suspensión de 200 mililitros.

 

 

I also wanted to consult. Which methodology can provide more precision? The two alternatives that I have available at the moment will be to take the solid medication, break up the pill, and weigh it in terms of milligrams, or continue with the liquid form methodology, preparing a 200 milliliter suspension. 💖

[Erimus]

On 7/4/2024 at 5:14 PM, Franco12 said:

Update on my evolution. On Monday, July 1, I had a ten percent increase in medication, a transition from 29 milligrams to 32 milligrams. Momentarily, the discontinuation syndrome does not seem to offer any ease. I would say I'm slightly better than about two weeks ago, but substantially worse than before surgery. Paradoxically, the surgery was precisely intended to reduce the complexity of discontinuation, since the calculation was basically that with better breathing I would have better rest, and deeper and more restorative rest would allow me to have significant advances in stabilization during tappering. What a mistake of innocence!!!!

 

The most uncomfortable symptoms since the exacerbation of the discontinuation syndrome due to the stress of anesthesia + operation + inappropriate reduction February - March are eminently in the order of cognition: less concentration, less naturalness in expressing myself, less capacity for memorization. In terms of physical symptoms, nervousness, restlessness, a constant but weak need to move. Honestly, the physical symptoms are irrelevant to me, the only circumstance that interests me is the evolution of cognition. If I have to remain forty more years with panic attacks or weak akathisia or migraines or gastric discomfort, I will give it little or no attention.    

 

Presumably the slight increase in medication (about ten additional milliliters) is with the intention of causing a decrease in the intensity of the discontinuation syndrome. 

Originally the plan was to remain on the same dose for a few more weeks, but after registering only a slight improvement three weeks after the operation , I thought it was the last opportunity to activate the reinstatement plan, since if more time elapses, the probability of mitigating the discontinuation syndrome with some type of increase will be increasingly elusive and distant.

 

In those terms, the current dose is 31.5 milligrams, about 126 milliliters of the 200 milliliter liquid suspension.

 

One question, Erimus. Strategically, the plan would be to make two or three increases (at intervals of three - four weeks in each increase). If after three or four increases I do not have any degree of remission of the discontinuation syndrome, then I will abandon the reinstatement plan (Let's say, I won't have any more raises), since without early signs of improvement I understand that the probability that successive increases will end in a mitigation of the discontinuation syndrome will be more remote. . In that sense, I would stabilize at a dose probably around 35-40 milligrams, and then start a 1.25% reduction plan for two-week intervals. 

 

Is it a rational medication administration plan? After the last episode of discontinuation syndrome, I have less confidence in my planning powers, and more fear of repeating unnecessary mistakes.

 

Honestly, I am more and more uncertain every day about whether I will ever feel like the old days again, without medication, without signs of discontinuation. I guess nostalgia is metastasizing inside me.

 

 

PD: Thanks for the suggestions, Erimus. 🌟 I am totally alienated in the administration of medication, because in the last few days I had a consultation with a psychiatrist, and again the same story: “I should have no problems in reducing medication, and the symptoms are the product of an episode of flowering of the underlying disease, and you should have no problem jumping from 30 milligrams to 50 milligrams over a period of two or three days." "Such a slow increase plan is an exaggeration on my part, typical of my inflammable mood and generalized anxiety."   

 

Obviously I cannot have any degree of trust in a psychiatrist, since it was first of all by entering a psychiatry office a few years ago (didn't I have anything more interesting to do that day?) that I arrived in such a complex position, and of so much vulnerability.

 

Better days will come, I hope. 💖

 

 

 

 

Increasing by 10% is much more rational than going straight back to 50mg. It is likely that things will improve as the weeks and months pass, and with this method of increasing, by the time you feel better your dose will still be less than 50mg. I have personal experience of increasing by 10% and 50%, and I can tell you that your current approach is without doubt the safer option.

 

I know how it feels to want to act and resolve your symptoms, this process of experimenting is something we must traverse ourselves.

 

On 7/4/2024 at 5:23 PM, Franco12 said:

También quería consultar. ¿Qué metodología puede brindar más precisión? Las dos alternativos que tengo disponibles al momento serían tomar la medicación sólida, fragmentar la pastilla, y pesar en términos de miligramos, o seguir con la metodología de forma líquida, preparación de suspensión de 200 mililitros.

 

 

I also wanted to consult. Which methodology can provide more precision? The two alternatives that I have available at the moment will be to take the solid medication, break up the pill, and weigh it in terms of milligrams, or continue with the liquid form methodology, preparing a 200 milliliter suspension. 💖

The liquid preparation allows for smaller reductions, as you can easily alter the dilution ratio. Other than that is is preference. I like crushing and weighing because I can prepare a full month of medication, hence I only have to do this 12 times each year.

Edited July 5 by Erimus

[Franco12]

Thanks, Erimus 🤝

[Franco12]

Hello Erimus!! 🌟🌟

 

A question. Can anesthetic substances applied during surgery themselves cause a discontinuation syndrome? Is there any precedent for this in Survivingantidepressants forums?

 

I know that after abrupt discontinuation of antidepressants, especially in the earliest weeks of discontinuation (even more in CT cases), gentle - low reinstatement of medication is recommended. Would that same principle apply to anesthetic-sedative substances?

 

Let's say, if we apply X substance during anesthesia, will it be recommended to add that X substance in a minimum amount to my pharmacological treatment plan?

 

Maybe I'm exaggerating the influence of those anesthetic-sedative drugs, but after my experience with drugs labeled as “antidepressants”, I couldn't stop asking, hahaha.

 

PS: I read the forum on anesthesia and surgery, but I did not find any allusion to low-dose installation of any of the sedative drugs exceptionally applied in surgery. From what I understood after reading the entry that you recommended, surgery with general anesthesia can be a highly destabilizing variable for the nervous system, and an exacerbation of symptoms is within expectations. It also represents a strong blow of stress for the body. However, I did not record anything about reinstatement of anesthetic medications or anything similar.

 

PS2: I know that the forum is specifically about discontinuation counseling - deprescribing psychiatric medications, and I understand that perhaps the question exceeds the limits of the forum.

 

SSSSSSSSSSSSSSSSSSSS

 

I guess I can use the query for an update as well. I have a little less nervous tension than previous weeks. The first fifteen days after surgery it was practically impossible to experiment with meditation, both due to the abysmal drop in concentration levels and also due to the urgent need to move, and the overwhelming feeling of depression

In recent days I can do meditation sessions, and those moments represent parentheses of rest in the incessant ocean of unpleasant moments that make up these days. I guess I'm under repair, hahaha 🔧 🛠️

 

Greetings, Erimus. 

 

 

[Erimus]

3 hours ago, Franco12 said:

Hello Erimus!! 🌟🌟

 

A question. Can anesthetic substances applied during surgery themselves cause a discontinuation syndrome? Is there any precedent for this in Survivingantidepressants forums?

 

I know that after abrupt discontinuation of antidepressants, especially in the earliest weeks of discontinuation (even more in CT cases), gentle - low reinstatement of medication is recommended. Would that same principle apply to anesthetic-sedative substances?

 

Let's say, if we apply X substance during anesthesia, will it be recommended to add that X substance in a minimum amount to my pharmacological treatment plan?

 

Maybe I'm exaggerating the influence of those anesthetic-sedative drugs, but after my experience with drugs labeled as “antidepressants”, I couldn't stop asking, hahaha.

 

PS: I read the forum on anesthesia and surgery, but I did not find any allusion to low-dose installation of any of the sedative drugs exceptionally applied in surgery. From what I understood after reading the entry that you recommended, surgery with general anesthesia can be a highly destabilizing variable for the nervous system, and an exacerbation of symptoms is within expectations. It also represents a strong blow of stress for the body. However, I did not record anything about reinstatement of anesthetic medications or anything similar.

 

PS2: I know that the forum is specifically about discontinuation counseling - deprescribing psychiatric medications, and I understand that perhaps the question exceeds the limits of the forum.

 

SSSSSSSSSSSSSSSSSSSS

 

I guess I can use the query for an update as well. I have a little less nervous tension than previous weeks. The first fifteen days after surgery it was practically impossible to experiment with meditation, both due to the abysmal drop in concentration levels and also due to the urgent need to move, and the overwhelming feeling of depression

In recent days I can do meditation sessions, and those moments represent parentheses of rest in the incessant ocean of unpleasant moments that make up these days. I guess I'm under repair, hahaha 🔧 🛠️

 

Greetings, Erimus. 

 

 

General anaesthetic is not something you want to be taking in a low dose post-op, you will not find a legitimate doctor that would prescribe this, and you do not get withdrawal from it. The problem is that the use of anaesthetic provokes the sensitised nervous system. There is nothing you can do about this now the procedure is done. All you can do is focus on recovery, and it sounds like things have improved a little in the last few weeks.

[Franco12]

Yes, some improvements both emotionally and in cognition. I suppose it is difficult to give corporeality to an optimistic vision, since the situation is still significantly worse than before the surgery. However, it is visibly better than the first fifteen - twenty days after surgery. For example, I can sit and read for hours (with weak concentration), while the first few days it was absolutely impossible to read a full page. I would say I am 20-30% better compared to the immediate post-surgery/discontinuation syndrome flare. 

 

The need to move constantly practically disappeared

 

Another symptom was mental emptiness. The first days it was impossible to identify spontaneous thoughts. I had to make a brutal effort to be able to chain a series of thoughts deliberately. In recent days I have spontaneous thoughts again regularly, especially in meditation sessions.

 

Thanks for the reply. Greetings, Erimus. 🌟

[Franco12]

Hello Erimus. I sent you a private message. I don't know if it arrived correctly, I couldn't find a private message history thread. ⭐