Brain: my brain on drugs

[Brain]

First, the facts:

 

The Drugs My Brain Has Been On

In decreasing order by length of time on the drug. Those I'm no longer taking are crossed out.

 

Zoloft (1998-present: 14 years)

Dosage: at 250mg most of that time. In Spring of 2009 began tapering in 25mg increments. Got down to 25mg by October 2010. Emotional crisis prompted return to 200mg. Reduced to 150mg in Sep 2012.

Side effects: Dry mouth

Estimated total mass ingested: 200 mg/day * 30 days/month * 12 months/year * 14 years = 1,008,000mg = 1 kilogram

 

Wellbutrin XL (2004-present: 8 years)

Dosage: started at 150mg, quickly ramped up to 300mg. Dropped to 150mg in summer of 2010. Emotional crisis prompted return to 300mg by end of 2010.

Side effects: Excessive sweating

Estimated total mass ingested: 300 mg/day * 30 days/month * 12 months/year * 8 years = 864,000mg = 0.864 kilograms

 

Klonopin (1998-2005: 7 years)

Dosage: at 1mg for most of the time, until I tapered it by .25mg increments. Taper was straightforward. Klonopin free since 2005 :-)

Side effects: panic attacks, lethargy, fuzzy thinking

Estimated total mass ingested: 1 mg/day * 30 days/month * 12 months/year * 7 years = 2520mg = 2.52 grams

 

Paxil (1997-1998: 1 year)

 

Geodon (2002: a few months)

Side effects: tardive dyskinesia (I still have occasional tongue spasms)

 

Honorable mentions: Zyprexa, Neorontin, clomipramine, lithium, St. John's Wort

 

Stuff That Helps Without Messing Up My Brain

Talking about my emotions

Socializing with friends and family

Playing Ultimate Frisbee

Prayer

Reading scripture

[Brain]

Second, some recent context:

 

In 2009 and 2010 I tried a fairly ambitious program of tapering off Zoloft and Wellbutrin XL. At the lowest point, I was down to 25mg Zoloft and 150mg Wellbutrin XL. Then my girlfriend broke up with me, and I moved, and daylight saving time ended. I became depressed, had anxiety problems, obsessive and unreasonable thoughts, etc. Also, my energy level had been low since reducing the Wellbutrin. So by the end of 2010 I was back up to 200mg Zoloft and 300mg Wellbutrin.

 

The fact that I have been quite stable at 200mg Zoloft for the last two years has encouraged me to try decreasing again. But this time I will stay on the Wellbutrin and only focus on the Zoloft. In September I dropped Zoloft to 150mg (175mg for two weeks, then 150mg). Withdrawal effects so far:

• One morning I woke up feeling like the room was spinning around me
• Random muscle spasms
• Tense muscles
• Anxiety
• Brain zaps?

[strawberry17]

Hi Brain

Love the intro!! super clear!!

The only thing I would say is, that is quite a big drop in the Zoloft in a very short space of time, the general advice is try no more than 10% and see how that feels. However, you could see how it goes, if you start feeling really rough you could updose to stabilize yourself.

I was on Zoloft for years myself.

If you look in the tapering forums there is loads of info on tapering different drugs and how to go about it.

Welcome to the forums!

strawberry

[xDebbiejo]

Welcome to the site Brain!

 

Sorry you have suffered, you will find plenty of help and support on here from people in similar situations.

[Jemima]

Welcome to the forum, Brain. Here are some specific tips on tapering off of Zoloft, and you'll find lots more information and friendly support on this site.

 

http://survivingantidepressants.org/index.php?/topic/1441-tips-for-tapering-off-zoloft-sertraline/page__p__13380__hl__zoloft__fromsearch__1#entry13380

[Brain]

Hi, all! Thanks for the greetings! Regarding the 50mg drop in Zoloft over a month, I understand that it's not recommended; however, my previous tapering experience gave me the idea that I'm not that sensitive to that rate of decrease at this high of a dosage. (I only really started to have trouble down around 50mg.) But I suppose that the fact that I have some withdrawal symptoms may indicate I should slow things down.

 

The real reason I do it this way is that I hate cutting pills. I have 100mg tabs right now, so as long as my dose is a multiple of 50mg then I can get the right dose just by snapping the tabs in half along the score mark in the middle. But when I go to a dose that equals 25+(50*n) milligrams (e.g. 175mg) then I have to start cutting things in half. Since I don't half a pill cutter but rather use a knife, it's a pain. Guess that for the next phase I should get a pill cutter and then stay at the non-multiple-of-50 dose for longer to ease the taper.

 

My plan for this phase is to stay at 150mg for 6 months. I really want to give my brain time to adjust. I wonder if that's even long enough? For the next phase, maybe I'll do 125mg for 3 months and then 100mg for three months. That should reduce withdrawal effects relative to doing the sudden 50mg drop like I did this time.

 

And now, some geeky thoughts about the mechanics of tapering:

The real question in my mind is whether it is the absolute size of the decrease that matters, or whether it is the relative size of the decrease that matters. If you specify the decrease as a fixed number of milligrams, then it becomes proportionally larger as you approach zero. On the other hand, if you specify the decrease as a fixed percentage to reduce by, then you never will reach zero

 

 

Also, should the taper be done at a constant rate, or should it be done in stages? Is it more beneficial to do 25mg drops every 3 months, or 50mg drops every 6 months? Does the brain adjust better/faster/with less withdrawal problems in the one scenario or the other?

[Brain]

P.S. Did anyone out there catch that I have consumed ONE KILOGRAM OF ZOLOFT in my lifetime thus far? Isn't that gross!? My poor liver....

[Altostrata]

Please read the topic Jemima posted for you, it's about tapering Zoloft http://survivingantidepressants.org/index.php?/topic/1441-tips-for-tapering-off-zoloft-sertraline/

 

We recommend a 10% relative decrease per month, calculated on the last dose. The doses get progressively smaller. If withdrawal symptoms occur, make smaller decreases. If no problem with a 10% reduction for a couple of months, you might try making reductions at 3 weeks or 2 weeks.

 

Smaller reductions more frequently are more tolerable than larger, less frequent reductions.

 

Past experience with dosage reduction is not predictive of future tolerance for dosage reduction.

[Brain]

It's update time.

 

Things have been quite stable since the taper to 150mg sertraline in the fall. Still at 300mg Wellbutrin XL, which is too bad because it makes me sweat a lot and the weather is starting to warm up :-P But for tapering purposes my sights are fixed on the sertraline and I'm leaving the Wellbutrin alone.

 

A week ago I dropped the sertraline to 125mg. I plan to stay at that dose for the rest of the month, and then drop to 100mg. I know some people probably won't approve since the drops are greater than 10%, but this is how I'm doing it. I have been amply warned, and I accept the risks. When I did this taper a few years ago, at an even faster rate, things were fine, so I'm not worried about it. At any rate, I plan to stay at 100mg at least until September to give my brain chemistry plenty of time to find a new normal.

 

It's sub-100mg where I expect things to get tricky and will likely adopt a 10%-increments approach. It's under 100mg where I start to feel what it's like to have a brain that isn't dominated by sertraline's numbing. Sertraline has been running my brain for the last 15 years or so, so when I got down to 50mg on my previous taper attempt, I felt things that I hadn't felt since I was a teenager. I noticed a great deal of obsessive thinking, and definitely more anxiety, and everything felt like a huge, overwhelming deal. It's tough to say what all the reasons were since I had also dropped the Wellbutrin to 150mg a few months before, and was having a bunch of traumatic life experiences in close succession, but my conclusion has been that the OCD-ish and anxiety symptoms were due to the drop in sertraline.

 

I wonder if part of my brain's functioning has been essentially frozen in time since I was a teenager, and now, when I reengage that part of my brain by reducing how heavily medicated I am, I simply don't have the skills for dealing with it? That's where the rubber really meets the road and I get to decide whether I believe my brain is at some level inherently broken, or whether it really knows what it's doing. Maybe I'll discover that the only way for me to function without sertraline is to find a different, less-stressful job, or to go live in the woods somewhere, or something like that. Maybe "depression" and "anxiety" are just signs that I'm not cut from the modern, fully-employed urbanite mold? Maybe my nature really is to be a mountain man or something?

 

Maybe I will need to go through a crisis at some point, and somehow, by surviving it without medication, I will learn something about who I really am and what I'm capable of. Not that I want to provoke a crisis. I hope to take the sub-100mg taper slow enough that withdrawal effects per se are minimized. But still it feels like I will have to face some tough stuff down there. What are people's experiences with emotional transformation once they come off of a medication? Is it true that the drugs have just been covering up feelings that can be dealt with more directly, such as by therapy? I'd love to hear what other people have experienced.

 

Thanks for any thoughts or comments.

[Altostrata]

It sounds to me like that dosage of Wellbutrin is too much for you. If I were you, I'd hold on the Zoloft taper and taper Wellbutrin instead. See http://survivingantidepressants.org/index.php?/topic/877-tips-for-tapering-off-wellbutrin-sr-xr-xl-buproprion/

 

I strongly suggest you get over your aversion to cutting up tablets and start taking care of yourself by tapering methodically.

[Brain]

Hey Alto, do you have any more details on why you think the Wellbutrin dose is too high? I spent something like 6 months at 150mg a few years ago and mainly noticed a big reduction in my energy level, as well as sweating less (which was nice). But can you tell me a bit more of your thinking there?

 

Regarding the rate of dosage reduction, I do not appreciate you pressuring me to conform to the 10% recommendation when I have already explained why I have chosen not to follow it at this point in my taper. As I have noted elsewhere, the 10% recommendation is not backed up by data, and while I believe it is a good and safe way to taper, it's not for me at this point. It's my brain, I've made these adjustments in the past, and I am acquainted with the effect it will have on me.

 

More generally, I disagree strongly with your previous claim that "Past experience with dosage reduction is not predictive of future tolerance for dosage reduction". If how my own brain has responded to the same reduction in the past is not indicative of how it will respond to that reduction right now, then by the same logic the fact that the sun rose yesterday and every day before has no bearing on how likely it is that it will rise again tomorrow. Taking note of what happened in the past is, in fact, one of the best ways of predicting what will happen in the future. It's not exact---clearly there's still some chance that I will have a horrible adverse reaction to the 25mg increments---but it's a much better predictor than anything else, and knowing myself I can say with a high degree of confidence that the 150->125 and 125->100 reductions with a month at 125 will be fine.

 

By the way, I do cut tablets to get the multiple-of-25mg doses. To get 25mg, I split a 100mg pill at the groove in the middle, and then use a knife to cut the halves in half. I just know that for me, the simpler the better, and the cost-benefit ratio at this point indicates that the benefits of simplicity outweigh the risks of withdrawal symptoms. Cutting things in such a way as would produce doses like 135mg, 122mg, 109mg, 98mg, 89mg, etc. as the 10% method would dictate is just not worth it to me when I know that I can do 25mg increments and be fine.

 

So, to sum up, I very much appreciate whatever feedback anybody has, and especially from you, Alto, given the breadth of your knowledge. But implying that my deviation from the 10% orthodoxy means I'm somehow not giving myself sufficient self-care seems a little heavy-handed. I'm sticking to the plan I have already outlined, for the reasons I have already outlined, and I ask you to please respect that.

[basildev]

Hi Brain,

 

I wanted to chime in here about the whole 'past experiences with dosages...' debate - only to say that I was really, really shocked at the end of February this year when I was hit with the worst insomnia of my life after a too-fast taper.

 

In particular, I was devastated by the fact in the past when I reinstated my medication (I've attempted tapering many times in my life), relief was, each and every time, almost instantaneous with the majority of my withdrawal symptoms disappearing after 3 days.

 

.....that is until this time. This time it's been 6 weeks of hell and I'm still suffering.

 

My point is that even though over many years my past experiences of dosage reduction and subsequent fallout have been pretty much predictable, I know that for me it isn't predictable any more. I've accepted that if this happens in the future, I really don't know what I'll be up against.

I think the more years you're on the medication the more complicated it becomes.

 

Of course, I'm not you and you're the one who knows your body (and your brain) the best. All the advice here really is given with the best of intentions and everybody here wants you to succeed. Those of us suffering withdrawal just don't want to see you suffering unnecessarily....that's all.

 

So anyway, I respect your decision and wish you the best of luck with your taper.

[Wingbatty]

WHY WHY WHY did you add up the total amount to one kilogram?? I can't even think about that one!

 

In all seriousness, I'm glad you found your way here, and wish you best with going off the meds. I've found great support & help here and hope you will, too.

[Altostrata]

Brain, I surmise the Wellbutrin dosage is too high because of the sweating, an indication of excessive activation. Wellbutrin is a noradrenergic; adverse effects are often due to excessive noradrenegic activity. If you are having one such adverse effect, it's likely others, such as increased blood pressure, are happening, too.

 

I say "Past experience with dosage reduction is not predictive of future tolerance for dosage reduction" because of the hundreds of cases of tapering and withdrawal syndrome I've seen. If you don't care for my advice, you are welcome to do it your way.

 

Sometimes people have to take a few turns in the withdrawal barrel before they get it. On the other hand, you might be lucky and not have problems.

 

Please keep us posted on how you do.

 

If you want more detail about tapering and the reasoning behind it, please read the topics in the Tapering forum.

[Meimeiquest]

Hi Brain,

 

I will chime in as a non-expert. First, the teenage issues...I was on an antipsychotic for 5 years.. When I got to a certain dose, it was like those issues were suitcases at my door waiting to be picked up, exactly where I left them. But at least some days I can think, and we've made a lot of progress in the past few months.

 

I greatly regret not tapering Wellbutrin first...you really want to get rid of the stimulating drugs first. Trust me, there are worse things than lack of energy.

 

Unopposed Wellbutrin makes me manic, even with lithium on board. Do you think you're thinking clearly when you're offended by Alto's way, who has given free, successful advice to 100s and you have only unsuccessful tapers behind you? Every drug change makes the brain less stable; sunrise is not destabilizing to the sun. And that is the most abruptly I ve ever written to someone on this forum . I hope it's helpful!

[Narcissus]

If how my own brain has responded to the same reduction in the past is not indicative of how it will respond to that reduction right now, then by the same logic the fact that the sun rose yesterday and every day before has no bearing on how likely it is that it will rise again tomorrow.

This does not follow.

 

The brain is neuroplastic, meaning that (unlike the motions of the earth) it changes constantly. This is especially true when taking/withdrawing from strong psychiatric medication.

 

I have tried twice to fully taper off Effexor, and both attempts have been markedly different in all aspects. Same brain, same medication, even the same time frame more or less, and yet very different experiences.

 

A recent attempt to make a small reduction took me by surprise and destabilized me almost completely. There is reason to think that the nervous system becomes more sensitized with each withdrawal attempt. This may not be true in your case, but there's nothing logically unsound about it.

 

Good luck and keep us updated.

[Brain]

Thanks for the thoughts, everyone. Yes, the neuroplasticity is an important point that I had honestly neglected, so you got me there. It certainly makes it less obvious what the result of dose reductions will be. To me it seemed that I had achieved a state of equilibrium in my 5 months at 150mg that was in all observable respects equivalent to the equilibrium I had achieved at 200mg. Given that I had 5 whole months to stabilize at that dose, I believe that is because the effects of the reduction had in fact all played out. I consider this one of the key advantages of my strategy---that there is more time in between reductions, thus making it more likely that brain systems have stabilized before making the next change. And while there is a more drastic drop up front, over the long run the average monthly rate of decrease is actually less than 10%.

 

At any rate, it's a different approach, I don't expect you all to like it, but hey, I'm willing to try the experiment. If I fail, you can say "I told you so". And if I don't, then you can all dismiss me as an outlier. And if you remember nothing else from this little discussion, just remember that nobody here has the data needed to prove things either way, and that that needs to change. We need data. We need to use statistics to model withdrawal effects and the merits of various tapering strategies. We should be able to give a mathematically justified estimate of the probability of my experiencing withdrawal symptom X if I taper from 125mg to 100mg next month. Until we arrive at that point, we're all engaging in (hopefully well-informed) guesswork.

[Rhiannon]

Just want to add, to put in your info bucket, that it seems common with ADs for people to "get over" their initial acute withdrawal symptoms and then be hit again around three to six months out with a "relapse" of anxiety and depression. This seems to be less of a problem with a slow taper.

 

I suspect that may have been part of what happened when you tapered down the Wellbutrin and sertraline before--the onset of obsessiveness and anxiety is not unusual for someone who has tapered quickly. I wouldn't confuse that with what it's going to be like to have a healthy brain again--that takes a while longer.

 

Probably because of the neuroplasticity of the brain and the fact that these drugs force it to change its natural state to adapt to the chemistry they induce, withdrawal effects seem to unfold over time, with a "lag" effect. It takes time to regrow a healthy brain.

 

I would also like to add that Altostrata knows as much as anyone--any doctor, any psychiatrist, any scientist or expert that I have encountered in three years of immersion in the world of psychiatric drugs and withdrawal--about what works and what doesn't in getting off ADs. I have the greatest respect for her intellect and her knowledge, and so do many doctors and activists and other people in the field. We're all incredibly fortunate that she does this work. It's your body and I absolutely agree that you are entitled to taper however you want to (I certainly do so myself!), but I wanted to give you the hedzup about the quality and level of expertise that's available here. I wouldn't be quick to toss it over the side.

[Narcissus]

If I fail, you can say "I told you so". And if I don't, then you can all dismiss me as an outlier.

You make it sound like our motive is to confirm some cherished doctrine of drug withdrawal at your expense, it betrays a weird and overly suspicious attitude. The 10% suggestion isn't sacred, it's just a cautious suggestion based on people's reports, reports that are the closest thing we have to the kind of data you're talking about.

 

If you want to try your own thing that's fine, I don't think anyone cares beyond feeling slightly concerned for you. I took large jumps like you're doing now, and after six months I still haven't recovered. I hope you have better luck than I did.

[Rhiannon]

If I fail, you can say "I told you so". And if I don't, then you can all dismiss me as an outlier.

You make it sound like our motive is to confirm some cherished doctrine of drug withdrawal at your expense, it betrays a weird and overly suspicious attitude. The 10% suggestion isn't sacred, it's just a cautious suggestion based on people's reports, reports that are the closest thing we have to the kind of data you're talking about.

 

If you want to try your own thing that's fine, I don't think anyone cares beyond feeling slightly concerned for you. I took large jumps like you're doing now, and after six months I still haven't recovered. I hope you have better luck than I did.

 

Agreed. It's odd to me too.

 

I'm always interested in the outliers, and honestly I think we all hope you'll do great and not suffer.

[Altostrata]

Brain, since you don't need my advice, it cuts down on the amount of time I need to spend reading your topic. Thank you for that, and good luck!

 

Please do keep us updated on your progress.

[Brain]

Brain, since you don't need my advice, it cuts down on the amount of time I need to spend reading your topic. Thank you for that, and good luck!

 

Please do keep us updated on your progress.

 

I guess advice wasn't really what I was after at this forum, anyway (my stubborn overreaction to everyone's advice makes that pretty clear.) I suppose I was more interested in discussion.

[Narcissus]

I wonder if part of my brain's functioning has been essentially frozen in time since I was a teenager, and now, when I reengage that part of my brain by reducing how heavily medicated I am, I simply don't have the skills for dealing with it? That's where the rubber really meets the road and I get to decide whether I believe my brain is at some level inherently broken, or whether it really knows what it's doing. Maybe I'll discover that the only way for me to function without sertraline is to find a different, less-stressful job, or to go live in the woods somewhere, or something like that. Maybe "depression" and "anxiety" are just signs that I'm not cut from the modern, fully-employed urbanite mold? Maybe my nature really is to be a mountain man or something?

Some interesting points here. I wonder too to what extent the drugs can 'freeze' our development. I think they do probably prevent us from maturing emotionally in some ways.

 

I'm not sure that anyone is really cut out for the 'urbanite mold'. I might almost say that psychological problems come with the territory.

 

I've always obscurely sensed in this whole withdrawal thing an opportunity to make some serious life changes. It seems like it could be conceived as a kind of awakening if approached in the right way. Maybe it's time to try something radically new?

 

I've also fantasized about following Thoreau's example and setting up in the woods somewhere. If you decide to try it and by some freak accident find yourself near a computer again, you'll have to let me know how it goes.

[Brain]

Just want to add, to put in your info bucket, that it seems common with ADs for people to "get over" their initial acute withdrawal symptoms and then be hit again around three to six months out with a "relapse" of anxiety and depression. This seems to be less of a problem with a slow taper.

 

 

I suspect that may have been part of what happened when you tapered down the Wellbutrin and sertraline before--the onset of obsessiveness and anxiety is not unusual for someone who has tapered quickly. I wouldn't confuse that with what it's going to be like to have a healthy brain again--that takes a while longer.

 

That would definitely make sense and explain what I experienced in the last attempt. I think I'll hold at 100mg for longer than 5 months so that if this relapse happens I'm not compounding it with further dosage reductions.

 

Probably because of the neuroplasticity of the brain and the fact that these drugs force it to change its natural state to adapt to the chemistry they induce, withdrawal effects seem to unfold over time, with a "lag" effect. It takes time to regrow a healthy brain.

 

So if there's a lag effect (which would make total sense) wouldn't you expect someone doing a 10%-per-month taper to be in a state of constant withdrawal starting 3-6 months into their taper? Does that happen? Or is it simply that the size of reductions is small enough that, though there is a lagged effect, it is not noticeable / less noticeable?

 

I would also like to add that Altostrata knows as much as anyone--any doctor, any psychiatrist, any scientist or expert that I have encountered in three years of immersion in the world of psychiatric drugs and withdrawal--about what works and what doesn't in getting off ADs. I have the greatest respect for her intellect and her knowledge, and so do many doctors and activists and other people in the field. We're all incredibly fortunate that she does this work. It's your body and I absolutely agree that you are entitled to taper however you want to (I certainly do so myself!), but I wanted to give you the hedzup about the quality and level of expertise that's available here. I wouldn't be quick to toss it over the side.

 

Thanks for your thoughts on this.

[Brain]

 

You make it sound like our motive is to confirm some cherished doctrine of drug withdrawal at your expense, it betrays a weird and overly suspicious attitude. The 10% suggestion isn't sacred, it's just a cautious suggestion based on people's reports, reports that are the closest thing we have to the kind of data you're talking about.

...

 

Agreed. It's odd to me too.

 

Yes, looking back at it I see that you're right and I was overreacting. I felt from my earlier posts that my tapering strategy is frowned upon here, so I guess I focused on that as a symbol of rejection by the community. But really I seem to have been playing the part of "arrogant newcomer", and I am sorry for that.

 

I have been finding these links helpful in moderating my views: [1] [2]

 

Again, sorry I've been obnoxious.

[Brain]

I'm not sure that anyone is really cut out for the 'urbanite mold'. I might almost say that psychological problems come with the territory.

 

I've always obscurely sensed in this whole withdrawal thing an opportunity to make some serious life changes. It seems like it could be conceived as a kind of awakening if approached in the right way. Maybe it's time to try something radically new?

 

I've also fantasized about following Thoreau's example and setting up in the woods somewhere. If you decide to try it and by some freak accident find yourself near a computer again, you'll have to let me know how it goes.

 

In my dreams, I work from home, where home is a cabin in the woods. Telecommuting from nature. So maybe someday I will let you know how it goes while I'm still in the woods :-)

 

I like the idea of a "nature deficit disorder". Whenever I do get out into nature, I feel so refreshed and alive!

[Brain]

Small update:

Reduced zoloft to 100mg at beginning of June. Intent is to stay at this dosage (100 zoloft, 300 wellbutrin xl) for a year to allow the hypothesized lag effects to play out. So far what I have noticed is some increase in anxiety, but it's manageable. Also, occasional stuttering. Who knows if this stuff is from the recent drop, or is lagged from the previous one.

[Rhiannon]

Small update:

Reduced zoloft to 100mg at beginning of June. Intent is to stay at this dosage (100 zoloft, 300 wellbutrin xl) for a year to allow the hypothesized lag effects to play out. So far what I have noticed is some increase in anxiety, but it's manageable. Also, occasional stuttering. Who knows if this stuff is from the recent drop, or is lagged from the previous one.

Good to hear from you! I'm glad things are going well. "Manageable" sounds good. 

 

You may not need to hold for a full year before you notice quite a bit of stabilization and improvement. It's always quite individual; I generally just encourage people to keep close track of their own symptoms and how they change and unfold over time.  

 

You asked earlier about "lag" and the 10% taper.  The lag effect that I so often see doesn't seem to be the same with every taper or with every medication, it's just something that I've observed happening frequently and that I think people need to be aware of.  

 

Generally what seems to work best is staying aware of one's symptoms and holding the taper whenever they seem to ramp up at all, without wondering too much whether the ramping up is due to a recent cut or due to some kind of delayed effect from previous cuts.  As long as the cuts have been small enough, even if one gets a bit ahead of the brain's ability to adapt to them, things seem to generally settle down when one holds the taper.

 

When people get into trouble is when they go too fast and ignore the warning signs of increased symptoms, and/or make such large cuts that if there's a delayed effect it's extremely destabilizing when it kicks in.

 

I hope what I'm writing is making sense. I've been up all night and my thinking's a bit disorganized.

 

Good luck to you!

[Rhiannon]

Would also like to add that I personally am of the opinion that holding (how often and how long) is just as important a factor in successfully getting off psych drugs as cuts (how often and what size).  So I'm interested to see how your approach works. I think the long holds will pay off for you.

[Brain]

Further update:

The surge in anxiety mentioned in my last post continued for most of August. It was accompanied by a general increase in energy and greater feelings of happiness. Fortunately, the anxiety has largely gone away and I'm left with an improved mood. Ability to feel emotions generally is also clearly improved, but not excessive.

 

I think much of the change in mood could also be attributable to recently finishing grad school 

 

Largely coinciding with the increase in anxiety, I noticed an increase in OCD-like thoughts and behaviors. Specifically, I noticed myself occasionally washing my hands more than I usually would. I believe this has also returned to normal.

 

It's interesting to compare my current situation to my situation three years ago when I was also in mid-taper:

• Right now: 100mg zoloft, 300mg wellbutrin XL, good mood, good anxiety/OCD, low stress employment, established in my community, better support network, etc.
• Three years ago: 50mg zoloft, 150mg wellbutrin XL, extreme depression, high anxiety, high OCD, high stress at school, recently moved, support network disruption, etc.

I'm nervous now mainly because three years ago things had for a while seemed to be going very well, until a sudden crash that fall. But there are important differences. This time, I'm leaving the wellbutrin alone, and I'm being less aggressive with the zoloft tapers. Three years ago, I had just moved into a new community, whereas now I have been in that community for three years and am established with a role I'm comfortable with and a stronger support network. Back then, I had just gotten out of an extremely painful relationship and still had to interact with my ex-girlfriend on a regular basis. Now, I feel my relationships are much more positive. Back then, my family all lived far away. Now, my brother lives close by. You get the picture... things are just better these days! So I'm hopeful that there will be no crash this time. But only time will tell.

 

In other news, I still think we need data to guide tapering strategies. To that end, I spent some time starting to develop an Android mobile app that would allow people to report on their taper progress, track others' progress, provide comments/encouragement, and other things like that. Supposing the app got any traction, the data on doses and symptoms gathered in this way could be extremely valuable and provide insights into what works and what doesn't. You could also test hypotheses about "lag effects" and whatever else by analyzing the data.

[Petunia]

Hi Brain,

Thank you for the update.  I briefly read through your thread and I agree, you are in a much better situation in your life now, to continue a medication taper.

 

If I understand correctly, you are going to begin by tapering the Zoloft.  Here is a link to our thread on tips for tapering Zoloft:

 

http://survivingantidepressants.org/index.php?/topic/1441-tips-for-tapering-off-zoloft-sertraline/?hl=%2Btapering+%2Bzoloft

 

Of course its only suggested advice, based on a lot of anecdotal evidence and experience, and you are welcome to adjust it to your own liking. 

 

But keep in mind that most people find that as the dose gets lower, the nervous system becomes more sensitive and tapering needs to be more precise.

 

I hope things go better for you this time and congratulations on finishing grad school.

 

Petu.

[Brain]

Hi all, just a quick status report. Since June of last year I have been at 100mg daily of Zoloft, retaining Wellbutrin XL at 300mg. In spite of an initial increase in anxiety at those doses, within a few months I stablized and the anxiety has resolved itself. Over the last 10 months I have been at least as stable as I have been at any higher dosage, and overall life is going well. I find that I feel emotions more intensely, which of course has pros and cons, but it's opening the way for me to learn to manage emotions with less assistance from medication.

 

And so, the transition to 100mg Zoloft has been an overwhelming success.

 

Though I had originally intended to hold at this dosage for one year, the 10 months already achieved seem sufficient to me given the successful outcome thus far. I also feel that for me spring is the best time of year to initiate dose reductions since the longer days naturally elevate my mood. And so I'm ready for the next step.

 

I've decided to reduce the Wellbutrin dose at this point instead of continuing with Zoloft reductions. There are a few reasons for this. First, I would like to allow even longer for any Zoloft-specific brain systems (not sure if such things exist) to adjust to last year's dose reduction. Second, I want to prove to myself that I can live without as much of an energy boost as Wellbutrin seems like it gives me. And third, I wish to reduce unwanted sideeffects from the Wellbutrin, especially the excessive sweating.

 

Regarding the rate of dose reductions, I decided to drop the Wellbutrin to 150mg directly and to hold there for the next two years or so, during which time I will (after an initial delay) continue the Zoloft dose reductions. I justified the drop to 150mg without intermediate tapers due to statements regarding Wellbutrin's amenability to such a taper schedule, and due to my own experience four years ago. Four years ago I also dropped from 300mg to 150mg of Wellbutrin XL. That seemed generally successful though I did notice a lack of energy, and though I did suffer an emotional crisis towards the end of that year. However, the OCD- and anxiety-type symptoms that the crisis was made up of suggested to me that it was my continued precipitous drops in Zoloft dosage (down to 25mg from 100mg within a few months) that were the cause of the crisis.

 

It's possible that I'm wrong in that assessment. If I find that to be the case, my contingency plan is to increase the Wellbutrin dose to 225mg (by using the SR form and pill cutting) in an attempt to ameliorate withdrawal effects. (This would be comparable to my return to 200mg Zoloft rather than my original 250mg Zoloft after a strong withdrawal response there four years ago.) I would then take time to stabilize and then proceed with a more gradual reduction schedule starting from 225mg.

 

With all that rationale in mind, on Wednesday I did reduce the Wellbutrin dose such that now I am taking 100mg Zoloft and 150mg Wellbutrin XL daily. So far so good, though obviously still early days. Assuming I experience no unacceptable withdrawal effects, the only question remaining for me is how long to hold at that dose configuration before resuming Zoloft reductions. I would appreciate recommendations.

 

Assuming this new dosage sticks, it represents the first step past the halfway mark. Relative to peak dosages, I am now taking 40% as much Zoloft and 50% as much Wellbutrin as previously. Thus I am overall taking less than half what I took at the height of my drug regimen.

[Altostrata]

Good to hear from you again, Brain.

 

I would have rather you dropped the Wellbutrin dosage more gradually, not only because we do have people here reporting withdrawal symptoms from Wellbutrin but also because your nervous system may be stressed from the Effexor adventures and it would be wise not to push it too much with other drug changes.

 

It's better to make more gradual changes than count on updosing to take care of problems. Withdrawal symptoms represent additional nervous system stress you might have avoided and sometimes updosing doesn't work.

 

However, some people do go off Wellbutrin rapidly with few problems and, if the stars are aligned, you will be one of them.

 

Please let us know how you're doing as time goes on.

[Rhiannon]

oh ouch me too, are you sure you can't make that reduction in a couple of steps at least?

[Rhiannon]

Also, congratulations on your overwhelming success with getting the Zoloft down to 100 mg! Way to go!

 

Of course I totally relate to wanting to take the Wellbutrin down now.  The reason I've done a multidrug taper is because I hated them all equally and wanted to reduce side effects of all of them. Makes perfect sense to moi.

 

And of course you have our support regardless of what you do with the Wellbutrin. I'm hoping it's a rousing success for you as well. Please keep us posted.

[Brain]

Eight months ago I dropped my Wellbutrin XL dose from 300mg to 150mg, while holding Zoloft at 100mg. Since that time there have been ups and downs (as human existence tends to) but I have been overall quite stable, in spite of potentially destabilizing shocks such as a death in the family and disruption of my social network. I've made it farther than in 2010 when I last attempted to reduce Wellbutrin, and I expect this reduction to stick.

 

Today I resumed reduction of my Zoloft dosage. Unlike past tapers, this time I mean to adhere to an exponential rather than linear reduction schedule, 10% per month. At this rate the dose should halve approximately every 6 months (since 0.9⁶ = 0.53).

 

Here are the doses I plan to go through, grouped into 6-month periods: 90, 81, 72, 64, 57, 51;      45, 40, 36, 32, 28, 25;      22, 19, 17, 15, 13, 11;      9, 8, 7, 6, 5, 4;      3, 2, 1. So it's basically a two-year taper down to zero. These aren't quite precisely 10% reductions versus the previous month since I'm rounding down at each step---so it's slightly more aggressive than it would be.

 

By contrast, an absolute 10% monthly decrease (90, 80, 70, 60, etc.) would take 10 months to get to zero.

 

I started implementing the 90, 81, 72, etc. plan today by dropping from 100mg to 90mg. I expect the usual stuff: increased anxiety, obsessive thinking, etc., which will then clear up leaving me with an increased capacity for human feeling and greater confidence in my own ability to handle life unaided by chemical "helpers".