Ringo: Tapering off of 300mg Wellbutrin XL

[Ringo]

Hello everyone!  I have been taking 300mg Wellbutrin XL for about 8 years. I am also taking 30mg of Cymbalta. I really want to taper off of Wellbutrin. I have extensively read the information on this site as to how to wean off of Wellbutrin. However, my problem is that my psychiatrist will not prescribe the SR or IR dosages. She insists that I just lower from 300mg XL to 150mg XL. I can't convince her otherwise. So, it seems my options are:

 

1. Lower directly from 300mg XL to 150mg XL and hope for the best. Then I guess I would eventually just discontinue the 150mg XL. But this seems too drastic of a drop for me as I am very sensitive to psych meds and have had terrible withdrawals trying to taper SSRI's and SNRI's. I have never tried to taper off of Wellbutrin.

 

2. Alternate days (as recommended by my pharmacist) by taking 300mg XL one day and 150mg XL the next day and do this for a "few" weeks (maybe 6-8 weeks), and then just stay on 150mg XL for awhile before tapering off of that. But would this be too destabilizing to my nervous system?

 

3. Take 150mg XL at 8 a.m., and cut up another 150mg XL into thirds to take 50mg at 12 p.m., 4 p.m., and 8 p.m. Then, I would be in a position to drop one third (50mg); changing the schedule to 8 a.m., 2 p.m., 8 p.m. I realize this is a little steeper than is recommended.

 

4. Or take 150mg XL at 8 a.m., and cut up another 150 XL into quarters to take 37.5mg at 11 a.m., 2 p.m., 5 p.m., and 8 p.m. Then, I would be in a position to drop one quarter (37.5mg); changing the schedule to 8 a.m., 12 p.m. 4 p.m., 8 p.m.

 

I know that I am not supposed to cut up XL tablets as they will turn into immediate release, but I am still wondering if this could possibly work.

 

Any advice is much appreciated. Thank you so much!

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[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  I think it's wonderful that you are wanting to taper off of Wellbutrin.  I have looked over your post and your drug history.  

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications, and why it's so important to taper slowly and carefully, and be very cautious about changing our doses: 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

 

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the reduction becomes exponentially smaller.

 

 Why Taper by 10% of my Dosage  

 

Tips for Tapering Wellbutrin

 

In light of the fact that you have made many drug changes over the past several years, and tried to taper Cymbalta this past year, I strongly suggest that you do not make any attempts to taper at this time.  It may be that your recent Cymbalta taper didn't work out because of the attempted Prozac bridge you did back in March, which probably destabilized your nervous system. I also noticed that you did your reductions faster than every 4 weeks.  We generally suggest waiting at least 4 weeks between reductions, if not longer. I believe that your nervous system needs a rest for a while from making any more drug changes.  I would take about a year and make sure to be very consistent in your dosing, not skipping or varying any doses.  We also strongly suggest you do not skip doses to taper, as this is a recipe for instability.  Our nervous system really need stability and consistency.  It's also very important to completely avoid alcohol, and other mind altering substances.  

 

My other question, is why the psychiatrist is so adamant about having you taper according to her plan?  You might consider finding a different psychiatrist or doctor who is more flexible and willing to work with you.  

 

How are your withdrawal symptoms at this time?  Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you. 

Magnesium

Omega 3 Fish Oil

 

 

Edited November 13, 2024 by getofflex

[Ringo]

Hello, and thank you so much for your response as well as all the advice! 

 

Yes, I have made many drug changes over the past several years, especially lowering Cymbalta since January of 2023. I just wanted so badly to get off it (or at least lower it), and did not realize just how impossible this seems to be! I am really frustrated and disappointed that this has happened to me as I experienced some anxiety and depression before starting on meds, but never this severe as when I attempt to lower or go off of them. If I ever knew about the changes these drugs make to our brains, then I would never have agreed to start taking them (I'm sure that is how many of us feel on this site). I will be sure to not make any attempts to taper at this time.

 

Yes, the Prozac bridge my psychiatrist had me do was terrible, and when I developed severe nausea/vomiting she said that I probably had the "norovirus." It was so upsetting to me that she said this, and did not believe that I was sick from the direct switch from 20mg Cymbalta to 20mg Prozac.

 

As far as my reductions, I followed the guidelines from the group "Cymbalta Hurts Worse." They recommend a 5% (or less) decrease every 2 weeks (or longer). So, once I was down to and stable (well, I thought I was stable) on 20mg capsules (average of 71 beads), I decreased by 5% every 2 weeks. Four months later when I got down to 47 beads my grandmother passed away and I went into severe withdrawal (severe anxiety, panic attacks, uncontrollable crying, sweating, nausea, dry heaves, jelly legs, insomnia, inner restlessness, difficulty eating, weight loss, etc.).  I will wait about a year before I attempt any tapering again as you recommend. I do completely avoid alcohol, but I do drink caffeine sometimes which I think I need to avoid as well. 

 

I did find a knew psychiatrist who seems to be more knowledgeable about these meds. He has his own podcast and has interviewed Robert Whittaker and Mark Horowitz along with many others. He does not want to make any changes to my meds currently. He is also a psychologist and is doing some counseling with me.  My last psychiatrist just wanted to add more psych meds. So, I am glad I made the switch to someone else.

 

I have been back on 30mg Cymbalta and have continued 300mg Wellbutrin for the past 8 weeks. My current withdrawal symptoms are still bad anxiety and lots of uncontrollable crying spells. I should mention that I suffer from chronic pain from an old injury which triggers anxiety and depression and is the reason I started on psych meds in the first place. So, pain is still a big trigger for me! I am also a mom of 2 kids (13 and 10 years old). So, suffering like this while being a mom is extremely difficult. I am married and work part-time as a dietitian in a local hospital. My husband is unable to deal with me being unwell during withdrawal. He runs a business and needs me to run the household. 

 

I have Magnesium Malate but have not taken it yet as I am afraid it will make my anxiety worse since it is energizing. I have also taken Magnesium Glycinate which strangely seems to give me insomnia sometimes. I have 100mg tablets and have started cutting up the tablets into quarters to start with 25mg. I took 25mg last Friday night and slept well with less anxiety the next morning. So, then I took 25mg again on Saturday night and was up until 2 AM. I ended up taking .25mg Klonopin to help me fall asleep. So, I am hesitant to try taking the magnesium glycinate again.

 

I do take 1920mg of Omega-3 (975mg EPA and 675mg DHA) + 1500 IU Vitamin D3 daily. 

 

I will continue to read through all of the material that you have sent me! Thank you!

[getofflex]

21 hours ago, Ringo said:

I will wait about a year before I attempt any tapering again as you recommend. I do completely avoid alcohol, but I do drink caffeine sometimes which I think I need to avoid as well. 

I'm glad to hear you are staying away from alcohol.  Yes, avoiding caffeine is also a good idea, as that tends to further activate our nervous systems.  Our nervous systems tend to already be overly activated while we are in withdrawal.  

 

21 hours ago, Ringo said:

when I developed severe nausea/vomiting she said that I probably had the "norovirus." It was so upsetting to me that she said this, and did not believe that I was sick from the direct switch from 20mg Cymbalta to 20mg Prozac.

I can understand why this would be upsetting.  Most of the doctors are in denial about how much dependency and withdrawal these drugs cause, unfortunately.  Hopefully, that is starting to slowly change.  

 

21 hours ago, Ringo said:

I did find a knew psychiatrist who seems to be more knowledgeable about these meds. He has his own podcast and has interviewed Robert Whittaker and Mark Horowitz along with many others.

This is fantastic!  You are lucky to have him.  Have you read Robert Whittaker's book "Anatomy of an Epidemic"?  It's very eye opening, about how the drug industry has so much control over the health care industry, and over the drug trials.  

 

21 hours ago, Ringo said:

My last psychiatrist just wanted to add more psych meds. So, I am glad I made the switch to someone else.

Very typical of most psychiatrists, as this is how they are trained.  

 

21 hours ago, Ringo said:

suffering like this while being a mom is extremely difficult.

I'm sorry to hear this - my heart goes out to you.  I'm sorry your husband is overwhelmed and unable to be more support to you.  Here is a link to something that may help him, if he is willing to read it: 

 

Helping Family Understand

 

Have you tried to calmly explain your situation to your 2 children, so that they understand why you are anxious and crying, and they understand that this is temporary, to alleviate their fears?  

21 hours ago, Ringo said:

I ended up taking .25mg Klonopin to help me fall asleep.

Please be really careful with klonopin, which is a Benzodiazepine.  They are highly addicting.  I wouldn't take them more than once or twice per week. I know the insomnia really sucks.  Here are some natural ways to help with insomnia.  

 

https://www.survivingantidepressants.org/forums/topic/25270-tips-to-help-sleep-so-many-of-us-have-that-awful-withdrawal-insomnia/?do=findComment&comment=658566.  - link about cognitive restructuring for sleep

 

Withdrawal Insomnia

 

And, here is some information to help with anxiety and crying spells.  These things are caused by the fact that your brain is physically destabilized at this time.  It is no reflection on your as a person.  As you hold, these should slowly lessen and improve.  

 

Neuroemotions

 

 

video: Claire Weekes: Managing Anxiety

 

video: Claire Weekes on Anxiety and Panic

 

Claire Weekes - Hope and Help for you Nerves Audiobook  

 

Emotional Spirals

 

Acknowledge Accept Float

 

Music to Calm Anxiety

 

Breathing Technique for Anxiety

 

Anxiety Stuff - all kinds of stuff about anxiety attacks and things that help ...

 

Audio:  First Aid for Panic (4 minutes) Female voice - getselfhelp.co.uk

 

Audio:  First Aid for Panic (4 minutes) Male voice - getselfhelp.co.uk

 

Meditation

 

Please be assured that if you hold on the drugs for at least a year, you will gradually feel better!  I held for a year myself when I started my taper in 2017 because I was going too fast.  I had not found this forum, and was tapering according to my doc's incorrect instructions.  When I finally found this forum in 2019 and started to taper according to the protocol here, things went a lot better, and now Ive been drug free for over 2 years!  You can achieve this too, but extreme patience is the key.  Keep in touch, and let us know how you are doing. 

[Ringo]

Thank you again for your response!

 

I will avoid caffeine as I can tell that it does further activate my nervous system as you said.   

 

I am currently a little more than halfway through reading Robert Whittaker's book "Anatomy of an Epidemic."  It is an excellent and very interesting book, but it does make me feel really upset as I am afraid that I will never really recover from the changes that these meds have made to my brain. 

 

It does make it harder for me to go through this without more support from my husband. He just doesn't really seem to understand how difficult it is to get off psych meds. He still thinks that "I need them." This surprises me because he is a smart person and I have educated him regarding everything that I have learned about these meds and how they truly work, along with explaining why it is so difficult to get off them. So, I am just really frustrated with him at this point. 

 

Yes, I have tried to explain my situation to my 2 children, so that they understand why I am anxious and crying.  They both seem to understand but they still seem bothered if they see me crying, so I try to hide it from them as best I can. My 13-year-old just retreats to her room. My 10-year-old gets upset if he sees me crying and either tell me to "stop crying" or he will run up to me and give me a hug. I just feel terrible that they must see me this way. I am afraid it will have a lasting impact on them in a negative way, possibly resulting in anxiety and/or depression as they get older.

 

I will try not to take anymore Klonopin, or at least won't take more than once or twice per week as you recommend since it is so addicting. The insomnia is better since the Cymbalta has been increased to 30mg. In fact, I seem to be more back to my groggy self and am barely able to get up in the morning to help get my kids ready and off to school. 

 

Thank you for the information to help with anxiety and crying spells.  I will be sure to ready through all the links that you sent. And thank you for saying, that this is not a reflection of me as a person.  Your encouraging words are helpful, especially since I don't get much encouragement from my family or friends. 

 

And thank you for your reassurance that I will gradually feel better as I hold over the next year! Congratulations on being drug free for over 2 years!  I really hope that I can achieve this too. I will try to be as patient as possible.

Should I check back in with you as it approaches one year of holding to ask for your guidance as to how to start tapering again? 

[j1290]

19 hours ago, Ringo said:

Thank you for the information to help with anxiety and crying spells.  I will be sure to ready through all the links that you sent. And thank you for saying, that this is not a reflection of me as a person.

Hi Ringo!    I'm not a doctor or a mod so I can't give advice, however I have tapered off of Wellbutrin so I can sympathize.  The struggle is real!   I started at 450mg, and now that I'm 15 months off, the emotional mood swings and anxiety have really improved.

 

If he's available, @Go2zerois a resident expert in how to taper Wellbutrin, and helped me a lot along the way.   The Wellbutrin Tapering thread is a lot to wade through and was confusing for me.  I must have gone over it 100 times and still made lots of mistakes along the way 😄   I ended up switching from the XL to the IR, which hit me much harder than the extended release, and tapering off of that, making a liquid near the end of my taper.  FWIW my doctor didn't have a problem switching me from the XL to IR, and in fact I got the prescription sent to Honeybee Pharmacy, where I could select what manufacturer the tablets came from.  They're not expensive and the pharmacy on my insurance constantly changed brands.   

If I recall correctly, I think Go2zero used an exacto knife to cut his XL tablets into small amounts and tapers that way.   Wellbutrin is challenging that way, with the different time releases it's not as cut and dry how to taper off of it successfully.   I I had to go down a lot of wrong paths before I found something that worked for me.   

 

Hang in there, and ask a lot of questions!  I have no doubt that if you stick with it, you'll find your way down this mountain.  All the best.

[Go2zero]

Hi Ringo,

 

Welcome on this forum. Some people here seem to see me as a specialist in Wellbutrin/bupropion. Not sure to say if I am, but I do have quite some experience with tapering this drug and did a lot of research about it.

 

First you should know that Wellbutrin/bupropion is a drug that many people can stop very easily, while others may have more problems with it. With all the research I did on this and with my own experiences, I have the idea that tapering Wellbutrin becomes more difficult when more drugs are taken next to Wellbutrin. But there are also people who only take Wellbutrin and still have lots of problems with tapering.

 

Another important thing you should know that Cymbalta is metabolised in the liver by CYP2D6 (among others). And Wellbutrin/bupropion is a quite potent CYP2D6 inhibitor.

 

That has several effects.

 

1) While the metabolism of Cymbalta is slowed down by the inhabitation through the use of Bupropion, the effect of 30 mg Cymbalta is stronger (af if you were taking a higher dose of Cymbalta).

 

2) When you start tapering the Bupropion while still taking Cymbalta, you should reckon that the metabolism of the Cymbalta will speed up. This means that you may feel as if you are tapering the Cymbalta as well, while still staying on 30mg...

 

This could be a reason to taper the Cymbalta first, before tapering Wellbutrin. But I mean to understand that you have severe problems with tapering Cymbalta. 

 

So if you want or need to taper Wellbutrin first, you should reckon with the speeding up of the Cymbalta metabolism. The best is then to be extra careful with the Wellbutrin tapering.

 

Looking at your posts and your signature, the best advice for now is to hold for a longer period in order to stabilise. Going up and down in dosages and also a Prozac bridge have most probably sensitised your nervous system. This will heal again, but it needs time. If you would make new changes in meds or dosages too soon this sensitisation may get worse and will take more time to heal.

 

When the time comes to taper the Wellbutrin, I would recommend option 4 from your first post. But with a change.... It is a good idea to take 1 150mg XL in the morning and 4 parts of 37,5 mg as a start. That is still 300 mg in total, but in this way you can adapt to the combination of 150 mg XL plus 150mg IR.  

 

Take at least 2 weeks to adapt and then you could lower the total dose with 10% (so 30mg). That would mean 3 pieces of 37,5 and 1 piece of 7,5mg. If that goes well you could taper 1 month later another 27mg (10% of the last taken daily dose). And so on. So do not take away 1 piece of 37,5mg as you suggested. That will go to fast! Stick to the 10% of the last taken dose. If that would give to extreme WD symptoms, you will need to go slower.

 

And yes, Wellbutrin XL CAN be cut. It just becomes Instant Release then. It is important however to divide the IR parts of your daily dosage over the day (best in 4 parts), since Wellbutrin IR can give an extreme boost if taken in a high dosage at once. And believe such a boost is no fun...

 

Here is a video I made how to cut Wellbutrin XL

 

 

 

[Ringo]

Thank you so much Go2zero!  I will continue to hold for the next year as recommended by the moderator on this site. This will bring me to next November 2025 in which I think I will try to taper Cymbalta again, before tapering the Wellbutrin. But, yes, I have been having a really hard time tapering Cymbalta, and I am going to have to go extra slow next time...maybe only removing 1 bead every 4 weeks or so. I will have to ask for more guidance from this site and also the Cymbalta Hurts Worse Facebook support group as to how to proceed with slowly tapering Cymbalta at that time.  Seems like it will take me years to taper just the Cymbalta, and then I also will have to taper the Wellbutrin. 

 

I will follow your guidance by taking 1 150mg XL in the morning and 4 parts of 37.5 mg as a start in order to adapt to the combination of 150 mg XL plus 150mg IR for 2 weeks as you recommended.  

 

Do I use the scale to make 7.5mg as you did in your video?

 

 

[getofflex]

On 12/2/2024 at 1:00 PM, Ringo said:

I am afraid that I will never really recover from the changes that these meds have made to my brain. 

Let me reassure you that you will recover from this!  Altostrata, the founder of this site, took 11 years to recover from a Paxil cold turkey, but she did recover!  

 

On 12/2/2024 at 1:00 PM, Ringo said:

He still thinks that "I need them." This surprises me because he is a smart person and I have educated him regarding everything that I have learned about these meds and how they truly work, along with explaining why it is so difficult to get off them. So, I am just really frustrated with him at this point. 

I'm sorry to hear this.  I can very much understand your frustration!  I'm really glad that you are educating yourself about them, so that hopefully you won't give in to any pressure from him to go back on them.  Just realize that you can always find support here.  If you have time, try going into other people's threads and offering them support, and then they might come in and offer you support too.  

 

I'm sorry it's upsetting your kids, but I think it is great that you are open with them about it!  Perhaps if you reassure them when you are having a window, that will help to offset this.  I still have crying spells myself, and I worry about it upsetting my 22 year old son who still lives with us.  

On 12/2/2024 at 1:00 PM, Ringo said:

I really hope that I can achieve this too. I will try to be as patient as possible.

Yes, you can do this!  The secret is patience, and going as slow as a glacier, if you need to.  Also, please try to learn and practice non drug coping skills! These skills will carry over into the rest of your life, and help you in many other areas now and in the future.  

 

On 12/2/2024 at 1:00 PM, Ringo said:

Should I check back in with you as it approaches one year of holding to ask for your guidance as to how to start tapering again? 

Yes, that would be fine.    IN the meantime, feel free to reach out for support if you need it!  We really truly understand in this forum what yo are going through.  

[Go2zero]

On 12/4/2024 at 5:33 PM, Ringo said:

Do I use the scale to make 7.5mg as you did in your video?

 

 

Yes, you can use such scales. Please understand that 7,5mg is the weight of the active ingredient. You should know the average total pill weight first. 

 

Best way to do this is to weigh at least 10 pills and find out the average pill weight. In my case (I use Wellbutrin by Glaxo Smith Kline) the average pill weight is 190mg (the active ingredient weighs 150mg). So in this case, when you need 7,5 mg active ingredient that will be 9,5mg in pill weight.

190/150x7,5= 9,5 

[Ringo]

Thank you so much for your responses. 

 

I received some advice from the "Cymbalta Hurts Worse" Facebook group to count out the exact number of beads to be taken daily, instead of just taking the 30mg capsule which can vary in the number of beads they contain.

 

I was told to take an average bead count of 3 capsules, which I did and came up with 112, 107 and 104. Then take an average of those counts (which comes to about 108 beads), and take exactly 108 beads at the same exact time everyday in hopes that this will help me stabilize as I am still experiencing a lot of anxiety and crying spells.

 

I have been doing this for almost 2 weeks with not much improvement yet. I was told to give it a month.

 

What are your thoughts about this?

[getofflex]

I don't have experience with Cymbalta, but this sounds like a good plan.  Stability and consistency in drug dosing is very important in finding nervous system stability.  Did you read this thread about stability?  I would suggest you do.  

 

Keep It Simple, Slow, and Stable

 

2 hours ago, Ringo said:

I have been doing this for almost 2 weeks with not much improvement yet. I was told to give it a month.

Yes, give it at least a month.  At least you have seen some improvement, which is a good sign.  It may even take longer than a month.  Patience is the key to this. 

[Ringo]

Thank you again for your response!

 

I have been taking exactly 108 beads at 9:30 AM for the past 16 days and have not noticed much of an improvement. In fact, I think I have felt a little bit worse lately with more anxiety and crying spells.

 

I will give it at least a month or even longer as you recommended. My patience is wearing thin as I am so desperate to feel better since I have 2 children as you know.

 

It's amazing how different the bead counts are in each capsule. I usually make a week's worth of capsules at a time. Yesterday I had to add beads to every single capsule since most of them had 105, 106, 107, or 102 beads.

 

It's so discouraging to have to actually add beads. But I guess this is what I have to do for now in order to hopefully stabilize.  

[Ringo]

Well, I screwed up again.

 

I'm trying to stabilize myself on an average of 108 beads (30mg) of Cymbalta daily. Therefore, I had to add beads to some of my capsules to make the 108 count as some capsules have 107, 106, 105 etc.  My grandmother recently passed away and I have some of her 30mg Cymbalta just in case I needed extra in the future. So, if I needed to, I used some of the beads from one of her capsules to make the 108 count if I didn't have enough. Well, I didn't realize that my 30mg Cymbalta and her 30mg Cymbalta are made by different manufactures. I have the Ajanta brand and she has PharMerica. Therefore, the numbers and strengths of the beads could be different. I started getting withdrawal symptoms again. Ugh...

 

So, I had to remake my capsules for the week using only beads from MY manufacturer. Hopefully, I will stabilize soon!