The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

[Altostrata]

I'm going to post this here so everyone can see it.
 
Our basic rules of succeeding with tapering off psychiatric drugs or recovering from withdrawal syndrome are the rules of 3KIS: Keep it simple. Keep it slow. Keep it stable.
 
1. Keep it simple.
 
When the body reacts, often it's difficult to tell what the cause might be. When you're tapering or trying supplements or other treatments, keeping it simple helps reduce confusion during trial-and-error. Keeping it simple minimize confounding factors. For example:
 
1.a. Do not CHANGE the dosage of more than one drug or supplement at a time.
When you change 2 or more drugs at once and you get a bad reaction, you won't know which drug is causing it.
 
1.b. Do not ADD more than one drug or supplement at a time.
When you add more than one thing at a time -- or, worse, throw the kitchen sink into some kind of cocktail -- and you get a bad reaction, you won't have any idea what to do. Should you drop one thing or all of them?
 
This is also true of mixed supplements, supplements that contain more than one ingredient. It's better to try one ingredient at a time to see how you react.
 
2. Keep it slow.
 
Many people become very sensitive to drugs and supplements after they've experienced withdrawal symptoms for even a short time. Do not count on taking the big risks you used to take. Make changes slowly.
 
Introducing a drug or supplement or changing a dosage very gradually gives you the ability to sample how it might affect you before you go too far. ALWAYS WAIT TO SEE THE RESULT OF A CHANGE BEFORE DECIDING WHAT TO DO NEXT. For many drugs, it takes 1-4 weeks to see the full effect of a change.
 
A big dose or big change probably will cause a worse bad reaction than a very small dose or change. You can injure your nervous system pretty badly with a big change -- it might take you months or years to feel better.
 
For example:
 
2.a. If you are tapering, we recommend a 10% reduction every month, based on the LAST dosage. (The amount of the reduction keeps getting smaller. Read this explanation: Why taper by 10% of my dosage?
 
2.b. Do not expect to feel better immediately. There are no silver bullets for withdrawal syndrome. There is no pill of any kind that will immediately put you back to normal. If you make a good change, the effect is likely to be slight at first. Be patient. Read this: What is withdrawal syndrome?
 
2.c. Do not jump around in dosage. For most drugs, it takes about 4 days for the change to fully register in your system. Unless you have an IMMEDIATE bad reaction, wait at least 4-7 days to see how the change affects you. Long-acting drugs, such as fluoxetine (Prozac),  do not reach full effect for several weeks. (If you have an immediate bad reaction, go back to the dosage you were taking before.)  See steady state graph for Cymbalta.
 
Since withdrawal symptoms ordinarily fluctuate, you might have hours or days here and there when you don't feel well. One episode does not a pattern make. Do not panic and throw in another drug or supplement. Keep notes on paper of your daily symptom pattern. If you feel worse and worse over a week, the change was not a good one. It may be the decrease or increase was too large. Rather than jumping around in dosage, make an adjustment half-way.
 
2.d. Be patient, recovery is inconsistent and gradual. The nervous system is very complicated. It can repair itself, but it takes time to do this. In the meantime, you may experience The Windows and Waves Pattern of Recovery
 
3. Keep it stable.
 
The nervous system is delicate and very complicated. Normally, the autonomic system runs your body with numerous checks and balances, constantly gauging what hormones and transmitters need to be increased and which need to be decreased. Its job is to keep your body stable, at a tolerable temperature range, with everything running smoothly.
 
Psychiatric drugs interfere with the entire nervous system, not just the brain. This is why changing dosage of just one drug can affect your eyesight, your digestion, and your sleep. Taking psychiatric drugs affects the functions of the nervous system.
 
The nervous system, which works so hard to keep your body running smoothly, thrives on stability. When you take a psychiatric drug over a period of time (usually a month or more), your body becomes dependent on the drug. This is called physiological dependency.
 
The nervous system adapts itself to the drug like a plant growing on a trellis. If you tear the trellis away, the plant will be damaged. You need to remove the trellis gradually and allow the plant to retrain itself to its natural growth pattern.
 
Thus, the nervous system does best in a stable environment. Help your nervous system adapt to life without drugs by maintaining as much stability as you can. This is the way you can take care of yourself and help your nervous system to recover. We are our own worst enemies when it comes to stressing our nervous systems! Examples:
 
3.a. Do not suddenly quit taking your drugs. Do not skip doses to taper. These big, fast changes are the opposite of providing stability for your nervous system. Skipping doses causes the amount of the drug in your bloodstream to go up and down. Do not do this for any psychiatric drug.  See this graph which compares skipping days vs daily dosing.

 

3.b. Avoid binges. Even if you had no problems with them before, avoid overindulgence in alcohol, food, partying, sugar, staying up late, even exercise. All of these put the body and the nervous system under stress.
 
3.c. Manage emotional stress. Yes, that abusive relationship can be keeping you from recovering from withdrawal syndrome. You may wish to reduce contact with any people who tend to upset you. If you are an argumentative person, you may wish to minimize your confrontations.
 
3.d. Direct your time and efforts to pastimes that are calming or pleasurable. Calm is good for the nervous system. Always make time for a pleasant walk of at least a half-hour every day. Many people find a place for meditation in their lives because it makes them feel better. Spending time with pets or in nature ("forest bathing") can also be soothing. See our Symptoms and Self-Care forum for more suggestions.
 
3.e. Keep your daily circadian rhythm steady. Your body runs on a daily pattern governed by sunrise and sunset -- the circadian rhythm. Our bodies do best when we wake in the morning, go to sleep at night, and eat at about the same times every day. You may wish to reduce artificial light at night. Do what you can to maintain a regular daily schedule, this helps your nervous system function. See Important topics about symptoms, including sleep problems.

Edited August 2, 2020 by Altostrata
updated

[wantmyhubbyback]

might be worthwhile to point out that published medical info on tapering schedules is incredibly wrong

 

https://www.documentforsafety.org/pub/forms/tapering_of_antipsychotic.pdf--25% a WEEK! yikes

http://www.medscape.com/viewarticle/529317#vp_2-- "4-8 weeks" -- yikes again!

http://www.nmsis.org/pages/preventdiscontinuationsyndromes2.asp-- "4 weeks to 3 months" -- still wrong.

 

who are the people writing this crap?

it continues to floor me that the psych community still doesn't understand or seem to care about getting people off of these drugs. i get the whole revenue stream, big pharma, "fox in henhouse' thing ...but still, wow.

[Altostrata]

At least they give some idea of what "tapering" means.

[Carouselisalie]

Great recommendations.

 

Capacity for self regulation is often lacking in those of us with nervous systems altered to adapt and survive traumatizing social environments. Limited self regulation is often what leads people to starting on anti-depressants and mood stabilizers in the first place.

 

Self regulation and groundedness are skills and capacities we can learn and develop. Good book: "Full Body Presence" by Suzanne Scurlock-Durama.

[Altostrata]

Good points, Carousel. Thank you.

[2befree4me]

Thank you so much for all your work on this site and advise.  This is an invaluable site and am so glad I found it.

 

 I personally love my two cats and one dog a jack russell, I will sometimes on my lunch break come home, lie down and let them all surround me with there love to help me get through the rest of the day.

 

just thought I would throw that in.

 

keep on keeping on

Xena

[Altostrata]

Thanks, dukke.

 

Some people do better with strenuous exercise and some do worse. It's something to try if you're in condition for it, but it can backfire.

 

Please let us know how you're doing in your Intro topic dukke: Tapering seroquel

[curineia]

 

 

Thank you for reminding me of this. ❤❤❤

Edited August 21, 2017 by mammaP

[Centime]

Really valuable info—thanks!

[Jill28]

I am sooo thankful for this site and these wonderful moderators. Now that I’ve calmed myself down, I’m able to digest this and learn from it. Thank you all❤️

[JackieDecides]

On 9/22/2018 at 6:35 PM, Jill28 said:

I am sooo thankful for this site and these wonderful moderators. Now that I’ve calmed myself down, I’m able to digest this and learn from it. Thank you all❤️

 

it's very true the more distress we are in, the harder it is to find, read, remember and use the information! 

 

big internet hugs to all of us! 🤗

[buzon624]

Excellent Advise.  Thanks so much for putting this together.  I wish I would have read this before I started my mass exodus from SSRI's.  Simple, slow, stable....thats a great mantra. 

 

Again, thanks to all who put time into this forum.  Seems to be helping a lot of people.  

 

All the best,

 

Andy 

[Lzieb]

Great advice. Thanks

[Bruci]

May I add that getting good psychotherapy can go a long way toward making this process easier. A good therapist can help you understand why you got depressed in the first place.

[getofflex]

I have put this mantra on my fridge. This week has thrown me into a wave with the stress of the holiday, a teen son who says out all night and other stressors.  I hope to get stable again very soon.  I’ll try to come up with a plan to have more stability at Chrismas. 

[Codepurple]

My post has not been reviewed it posted. Any suggestions?

[DataGuy]

On 3/9/2021 at 12:45 PM, Codepurple said:

My post has not been reviewed it posted. Any suggestions?

 

It's been approved now. It can take awhile. Sometimes posts will get lost because everyone is a volunteer and we are all pretty busy or experiencing withdrawal ourselves. Hope you find the site useful : )

[Waving2MyWindows]

i wish i saw this a long time ago

[Nivsch]

I have questions about the "Keep it stable".

 

I do significant efforts to make my dose as stabe as possible. one of the things that I do is to make the maximum distance between the drug and food, because I have read that food can decrease absorption by couple of %, and I know that even 2% of day to day change in absorption is still really significant in withdrawal. but I still have some concerns about the stability issue ,so my questions are:

 

1. What do you think about that?

 

2. How much time it takes until the drug bypasses the stomach and reaches the small intestine? in my case I take cymbalta and I have gastro resistant capsules with 375 enteric coated micro beads (my current dose) to delay absorption.

 

3. Is there a concern that if I take it when the metabolism is very slow - before sleep/too early in the morning or when I keep lying in bed after I take it - that the capsule will partially dissolve in the stomach? 

 

4. Can we say that maybe it is important to eat something even a little bit to make the stomach move and ensure the drug will pass the stomach in one piece? Or that all these parameters are negligible?

 

5. Does my drinking habit during the day affects the absorption phase and I should keep it the same as possible every day? or this is negligible?

 

6. anything else from your knowledge/experience that can help the dose be more stable?

 

Thank you.

[Tryinghard]

Great advice!!!! I got answers to almost all my questions in this post. Thank You for this

[Jimmyt]

I posted this question in my intro stream but wondering if this is a better site. Confused about the jumping around versus keeping it stable? (See quote below highlighted in bold).

 

Do not jump around in dosage. For most drugs, it takes about 4 days for the change to fully register in your system. Unless you have an IMMEDIATE bad reaction, wait at least 4-7 days to see how the change affects you. Long-acting drugs, such as fluoxetine (Prozac),  do not reach full effect for several weeks. (If you have an immediate bad reaction, go back to the dosage you were taking before.)  See steady state graph for Cymbalta.

 

in my case went from 25 mg Sertraline to 27.5 mg to account for experiencing withdrawal symptoms I believe from the stoppage of a non-psychotropic medication that was affecting the Sertraline absorption. After 5 days I dropped back to 25 mg as I was feeling worse and reconsidered the whole strategy. Now 7 days later I’m feeling even worse. 
 

My general question is at what point are you better off to just hold versus now making a small adjustment, say in this case back up by 0.5 mg maybe?

 

My gut instinct is to stop jumping around but as the quoted post above mentions, perhaps a small increase might help?
 

 

 

 
Since withdrawal symptoms ordinarily fluctuate, you might have hours or days here and there when you don't feel well. One episode does not a pattern make. Do not panic and throw in another drug or supplement. Keep notes on paper of your daily symptom pattern. If you feel worse and worse over a week, the change was not a good one. It may be the decrease or increase was too large. Rather than jumping around in dosage, make an adjustment half-way.

[Tryinghard]

I usually go very very slow I am not weighing on scale that seems like too much work for me i just break a tiny piece off the pill and continue same for 1 month, 1 month is enough time to tell me if withdrawals are coming or not then 2 tiny pieces for next month , it's a long process but I was able to leave my morning dose of rivotril completely, and just 1 type of pill at a time

I hope this helps

 

[Steveeeej]

Thanks for your comments, your advice and caring manner is wonderful.  

I will be starting to taper off of zoloft after I consult Dr Mark Green , I am on his waiting list, and will be conversing with you then. I have been on sertraline for about 25 years, current dose 100mg. I am also on 150mg of Lamictal starting g in 12/2019. I quit the sertraline  cold turkey twice years ago and almost lost my mind.  Curse the people who put me on them for not educating me and shame on me for not educating my self. I was so strung out I didn't even think to do my due diligence,  I  don't blame myself for this I was doing my best.

My Functional Medicine doctor put me on the Lamictal and again I had to educate myself about the drug. I thought that it was an epilepsy drug additionally used for elevating mood and modulating glutamate. I didn't realize that tapering off of it was the same as an ssri. Had a bad episode in the past month of altering the dose because I was so anxious and confused, very scary. Back on 150mg and feel better now.

I tapered off of the zoloft starting January 2022 and got down to 25mg but by the fall of that year I was getting very anxious and my FM doc sent me back up to 100 in one leap. 

As you can see I don't believe that I am getting good advice from FM doc which is why I am going to consult Dr Green.

I am so looking forward to being drug free and am grateful for this site.

Thank you so much for listening, 

Steve Jesus

Steveeeej