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Why taper by 10% of my dosage?


Altostrata

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ADMIN NOTE This topic is a general discussion of the principle of tapering. For case-by-case consideration of what YOU should do, please put your questions in an Introductions topic.
 
Do not put those questions in this topic, because detailed discussion of YOUR particular circumstances will take it off track and make this topic difficult for others to follow. The moderators will move any questions about YOUR particular case to the Introductions forum. Thank you.

 

For tips about tapering individual drugs, see Important topics in the Tapering forum and FAQ

 

For scientific data supporting very gradual tapering, see Horowitz, 2019 Tapering of SSRI treatment to mitigate withdrawal symptoms 

 

This paper is based on the concepts discussed in our topic Why taper? Paper demonstrates importance of gradual change in plasma concentration referring to Meyer, 2004 and other research into SERT transporter occupancy.

 

From correspondence with Dr. Horowitz: "...all pharmacological relationships are hyperbolic so the pattern of exponential reduction that you recommend is likely to apply to any target no matter what it is."

 

Dr. Horowitz has published a handbook for hyperbolic tapering, The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs

Mark Horowitz, David M. Taylor 

 

It may be purchased from several sources in e-book form and will be available in print February 21, 2024.

 

In your tapering, you may follow the Maudsley handbook if you like. As explained in this topic, the 10% exponential taper approximates the hyperbola described by Dr. Horowitz. For those who do not have the handbook or cannot follow its tapering charts, calculating a 10% (or lesser) exponential reduction is a user-friendly way to taper.

 

With its hyperbolic calculations, the Maudsley handbook indicates more precise jumping-off points at the end of the taper, but they're only suggestions. Whether they taper exponentially or hyperbolically, people will need to use their judgment, based on their tapering experience, to figure out when they can end their taper. Either exponentially or hyperbolically, the end will be somewhat less than 1/40 of the original dose and a fraction of a milligram for most drugs.

 


SUMMARY OF EXPONENTIAL TAPERING

 

1) We recommend starting with a 10% taper per month, based on the last (not initial) dosage. The month allows time to see the effect of the reduction. If you get significant withdrawal symptoms, you will not want to make another reduction as large as 10%. Making another reduction while you have withdrawal symptoms causes worse withdrawal symptoms.

 

If you feel adverse drug effects, they tend to reduce along along with dosage reduction, even if you follow this conservative taper, it is likely you will feel less intense adverse drug effects after a few reductions. They probably will continue to get less intense as you continue a gradual taper.

 

(If you are taking an antipsychotic or other drug that might cause a movement disorder, you are in a difficult position, because if you taper too fast, "dopamine supersensitivity" might bring on or aggravate a movement disorder or cause symptoms that might be mistaken for psychosis. You will need to taper at a rate that does not cause you to be hospitalized for psychosis, where you probably will be given more drugs. To substantially reduce an antipsychotic, you probably will not be able to rush a taper -- unless you have life-threatening adverse drug effects, where you might need to consider options 2 or 3.)

 

2) If you are suffering adverse drug effects, you may wish to taper faster, such as 10% every 3 or 2 weeks, but you need to balance the adverse drug effects vs risk of withdrawal if you taper too fast. You can have both adverse drug effects AND withdrawal symptoms, which you will not like.

 

3) If you are experiencing severe adverse drug effects, such as outright kidney or liver damage, you may wish to go off the drug within a few weeks, or even quit it abruptly, again risking withdrawal symptoms, which might be severe and long-lasting but may be preferable to organ damage.

 

4) None of these methods guarantee you will not get ANY withdrawal symptoms, but a more gradual taper is likely to cause milder withdrawal symptoms.

 

You are the expert on severe your adverse drug effects might be. For example, if you've been coping with the adverse drug effects for months, going to work, etc., that would not be at the topmost severity. If you've gotten abnormal liver tests, you may wish to employ option 2, a faster taper that risks withdrawal symptoms.

 

Option 3, abrupt discontinuation, offers the highest risk for withdrawal syndrome, and might require hospitalization.

 


 

This site exists because doctors are unaware of the greater safety of gradual dosage reduction, usually advise tapers that are too fast, do not sufficiently recognize withdrawal syndrome, and do not know what to do if it occurs.

 

According to the medical journal literature on antidepressant withdrawal syndrome, anyone who has been taking a drug for a month or more is at risk.

 

The 10% taper recommendation is a harm reduction approach to going off psychiatric drugs. While it is not a guarantee you will have trouble-free withdrawal, we believe this conservative tapering method will cause harm to the fewest number of people.

In a nutshell, the 10% taper method recommends a 10% dosage reduction every 4 weeks, with the 10% calculated on the last dosage. The amount of decrease is proportionate to the last dosage (not the original prescription) and keeps getting smaller.  

 

(In mathematical terms, this is exponential decay.)

 

A linear reduction of 10% on the original dose results in reductions being a larger and larger proportion of the dosage you're taking currently.  (See graph comparisons at the bottom of this post.)  These larger decreases tend to be destabilizing and cause withdrawal symptoms.

 
Those finding the 10% exponential reduction method too slow can speed up by making 10% (or less) reductions more often. Making smaller changes more often is less likely to perturb your nervous system than larger changes less often. However, if you get withdrawal symptoms, your nervous system is telling you that you are tapering too fast no matter your method.


The 10% per month reduction method is recommended by

 

In addition, for scientific data supporting a very gradual taper, see this paper Meyer, 2004 Serotonin transporter occupancy of five selective serotonin reuptake inhibitors at different doses: an [11C]DASB positron emission tomography study.   Discussion and full text here
 

On 4/13/2014 at 11:53 AM, Rhi said:

....
When you open the document go to page 4 and look at the charts. You will see that at lower doses you must taper EXTRA slow, not faster. At higher doses, when you cut 1 mg, it only reduces your receptor occupancy by a small amount; but from 1 mg down to 0 you drop from 20% occupancy straight down to zero!
 
That's why we say calculate your cuts based on 10% of your CURRENT dose. (Or a smaller percentage....
....

 

The SERT occupancy charts are the foundation of the Horowitz-Taylor hyperbolic tapering method described in Horowitz, 2019 Tapering of SSRI treatment to mitigate withdrawal symptoms , a good paper to take to your doctor.
 
Why decrease by such a small amount?

The risk of severe withdrawal is so great for some people, a very conservative approach to tapering to protect everyone is called for.

 

Do not assume you will be lucky, if your taper goes wrong, it can take a very long time for you to recover.

Many people seem to be able to taper off psychiatric medications in a couple of weeks or even cold-turkey with minor withdrawal symptoms perhaps for a month or so. Doctors therefore expect everyone can do this.

 

However, estimates dating from the 1990s suggested 20%-80% cannot go off quickly -- they suffer acute withdrawal symptoms and then post-acute withdrawal symptoms for much longer.. A recent paper, Davies and Read, 2019,  found about 45% experienced significant withdrawal symptoms.

 

You can't know how your nervous system will respond to a decrease in medication until you try it. If you go too fast, won't know if you're in the unlucky half until it's too late. It's a lot easier to taper slowly than to put your nervous system back together again after it's injured.

 

If you've had withdrawal symptoms or adverse reactions before, you are likely to have them again. Be careful, because an injury to the nervous system is like any other injury -- it can take time to heal. Repeated nervous system injuries cause more and more intense symptoms -- a phenomenon called "kindling."

From reports of withdrawal syndrome all over the Web, those concerned about withdrawal syndrome have come to a consensus: Decreases of 25%, which are recommended by many doctors, are too large, with many people develop withdrawal syndrome. The peer support sites are filled with people who tried their doctors recommendation of "cut your dose in half for a week, then cut it in half again for a week, then stop."

 

Thus, the recommendation of the more gradual 10% reduction.

 

(Another popular taper method, skipping doses or alternating dosages, also produces a lot of people with severe withdrawal symptoms. See this link which includes a list of research papers:  NEVER SKIP DOSES TO TAPER )
 

But aren't withdrawal symptoms minor and transient?
Withdrawal symptoms represent neurological dysfunction. They are not normal and should not be ignored. Severe symptoms can be distressing, debilitating, or even disabling. If you get prolonged withdrawal syndrome, there is no known treatment or cure. You will have to cope with it until it goes away.

According to Joseph Glenmullen in The Antidepressant Solution (2005), tapering should incur almost no withdrawal symptoms.

It's a Humpty Dumpty situation. Once your nervous system falls off that wall, there's not much that can be done to put it together again.  (Humpty Dumpty is a character in a children's nursery rhyme - he is an egg.)

 

If you are a person who is sensitive to fluctuations in your dosage, you may have a lot of difficulty tapering. For these people, even if the original dosage is reinstated, withdrawal symptoms may continue to be severe.

It makes more sense to start slow, to protect your nervous system, and increase your rate of taper if you can find you can tolerate a faster withdrawal.

A 10% decrease per month lessens your risk

Some guides will suggest a trial decrease of 25% to start. If you get withdrawal symptoms, it is recommended to reinstate the original full dosage and taper more slowly from there.

BUT -- it can take weeks to feel the full brunt of withdrawal symptoms from an initial drop. It makes sense to wait a month between decreases, to observe the effect.

 

If instead of observing for a month, you have forged ahead and already made more reductions, you may be surprised by a flare in withdrawal symptoms, indicating substantial neurological dysregulation. You could be suffering quite a bit for a long time.

To save wear and tear on your nervous system, we recommend an initial drop of 10% and staying at that level for a month to see if withdrawal symptoms develop.

Very mild symptoms that last only a few days are acceptable. If they last longer, you may wish to updose slightly and make smaller decreases each month. If you are sensitive, smaller decreases can protect you from a great deal of pain and discomfort, even though the overall taper may take longer.

Can you taper faster?
Many people do fine with a faster taper. Are you one of them? You can't tell ahead of time. If are not sensitive to a 10% drop, by listening to your body, you may be able to make 10% drops more often than every month.
 

Once you find out your symptom pattern, you can adjust your taper rate. It's best to go slowly at first to find out how you react to a reduction.

 

If you feel withdrawal symptoms longer than a few days after a reduction, you are not a candidate for tapering faster. Most people will stabilize (stop feeling the effect of a dosage change) after a reduction within a week.

 

We recommend reductions at monthly intervals to give the nervous system a good 3 weeks to settle down between cuts.


Always err on the cautious side. Once you damage your nervous system with withdrawal symptoms, it can take a very long time to feel good again.

The 10% method protects everyone. You have the option of tapering faster if you can tolerate it.

If you think you can taper faster than 10% per month, follow this harm reduction approach to starting your taper:

  • Initially, make a 10% reduction and hold there for a MONTH. It can take several weeks for withdrawal symptoms to emerge. Do that again the second month.
  • If you have very minor or no symptoms from these 2 reductions, you can try reducing by 10% (calculated on the last dosage, the amount of decrease keeps getting smaller) every 3 weeks. Do that twice. If no problems, you might be able to reduce by 10% every 2 weeks.
  • Be prepared to adjust your rate of taper. When you get down to a lower dose, often you will have to taper SLOWER, or by even smaller percentages.
  • If significant withdrawal symptoms appear at any time, STOP TAPERING. Hold at your current dosage for some months, stabilize, then make smaller cuts or go slower. Listen to your body.
  • If you get withdrawal symptoms that do not go away after 2 months, consider a slight updose and hold to stabilize. You will not be able to taper faster than 10% per month after that, and may need to go even slower.
  • "Jump off" at the end when you are taking less than 98% of the original dose and reductions no longer cause any reaction at all. Usually, this is less than a milligram of the drug.

 

Under this method, the fastest taper takes about 12 months.

MIND-UK's Coping With Coming Off Psych Drugs Guide explains it like this (on the Icarus Project Web site😞
 

Quote

Allow enough time for your body to readjust to the lower dosage at each stage. You could start by reducing the dose by 10 percent, and see how you feel. If you get withdrawal effects, wait for these to settle before you try the next reduction.....At each stage, if you find the reduction too difficult to cope with, you can increase the dose slightly (not necessarily back to the previous dose) and stabilise on that before you continue.

 

What if I have to taper slower than 10% per month?
If you are very sensitive to dosage reductions, you may have to reduce by very, very small amounts, less than 10% per month, or hold for even longer than a month at a time.

Everyone is different; you'll want to do what's best for your nervous system. This can make tapering a project lasting years. Still, you are minimizing your drug burden.

See the discussion about this here: The slowness of slow tapers

 

If I taper by 10% taper, how long until I can go off the drug completely?

 

On 5/25/2018 at 11:39 AM, brassmonkey said:

The time it takes is all in the mathematics of a logarithmic progression  It doesn't matter where you start it's going to take so many steps to cut your dose by a certain amount. For our recommended basic taper of 10% every four weeks that gives a [half-way point] of six months.  So every six months you will cut your current dose in half.  This makes it so at the higher doses you will see larger decreases over that time spam. I started my taper at 40mg [active ingredient].  After six months I would be at 20mg [active ingredient] and at the end of a year 10mg [active ingredient].  Another year and I'd be at 2.5mg [active ingredient]. Wait a third year and I would be nicely below 1mg [active ingredient] at about .75mg [active ingredient].  It keeps going like that until you reach a point that you consider it safe to make the jump.  

 

....Also if you change the percentage of taper you will change the [half-way points]. If you do a 5% taper every four weeks you double the time it takes. So at 5% your taper [half-way point] would be 12 months and at 2.5% it would be 24 months.

 

Generally, people go off the drug at dosages less than a milligram, depending on the drug. While these tiny dosages are not "therapeutic," meaning not effective to treat depression, etc., they are surprisingly powerful in their effect on the nervous system. When they are removed, you may well feel mild withdrawal symptoms.

 

If the withdrawal symptoms are severe or last more than a few days, reinstate the last dosage immediately and allow your system to stabilize. You can go off the last bit by even tinier amounts later.

 

GRAPHS - both graphs start at 100mg dose for the period 1 January 2019 to October 2022.

Note the difference in the "jump to 0" dates.

 

The following shows a LINEAR taper reducing 10% of the starting dose every 4 weeks.

 

2085894134_LINEARTAPERcomparetoPERFECT.thumb.png.6c1b9777b4b4587bf29a425785f9344d.png

 

The following shows an exponential taper of 10% calculated on the last dose every 4 weeks. 

This shows tapering from 100mg to 0mg, but the curve would be the same for any starting dose.

 

776391214_PerfectTaper.png.f16551da35c66ed2616e7cdd534b7505.png

 

 

IMPORTANT: IF YOU ARE HAVING A SEVERE ADVERSE REACTION TO A DRUG, YOU MAY WANT TO GO OFF FASTER. Some adverse reactions, such as abnormal liver tests or strong allergic reactions, indicate potential organ damage. You may want to accelerate a taper or, in extreme cases where the adverse effects are as great a risk as severe withdrawal syndrome, quit the drug immediately and accept the risk of withdrawal.

 

This is a difficult problem, because you will need to assess which is worse, adverse drug effects or the withdrawal symptoms you might get from reducing your dosage. It is possible that if you taper too fast, you will have both adverse drug effects from the doses you're still taking AND withdrawal symptoms.

 

Adverse effects generally decrease as the dosage decreases, but the withdrawal symptoms may take over and be just as bad.

 

We generally advise very gradual tapering at 10% per month to start. But if the adverse effects are intolerable or disabling, you may wish to risk a faster taper, perhaps smaller reductions, such as 5% more often, rather than larger reductions at any one step.

Edited by Altostrata
updated admin note

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 5 months later...
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Also see Dr. Peter Breggin's 10% taper method from Your Drug May Be Your Problem: How And Why To Stop Taking Psychiatric Medications by Peter R. Breggin and David Cohen.

Please note that the 10% reduction method we recommend on SurvivingAntidepressants.org is a 10% reduction on your CURRENT dosage, not the original dosage of the drug.
 
If you have been tapering, you calculate the 10% on your last dosage. The amount of the decrease keeps getting smaller for the duration of your taper.

- If you started at 10mg, the first reduction would be 10% of 10mg, or 1mg, for a reduced dose of 9mg.

- Your second reduction would be 10% of 9mg, or .9mg, for a reduced dose of 8.1mg.

- Your third reduction would be 10% of 8.1mg, or .81mg, for a reduced dose of 7.29mg.

And so on.

This ensures that your nervous system is eased down a gentle 10% slope at every step of the process. It's important that drops become smaller, not larger, as you go. Once you find the rate at which you can comfortably taper, you don't want to jolt your nervous system with a larger drop than it can handle.

Mathematics whizzes may recognize that the 10% reduction formula is a geometric progression (asymptote) approaching but never equaling zero. At a very small dosage, likely less than 1mg, when reductions no longer cause any withdrawal symptoms, you may want to simply stop.

You will need to use your own judgment about your jumping-off point. Some people have found that, to avoid withdrawal symptoms, the final steps require reductions so tiny they cannot measure them, employing methods such as dipping a toothpick in a liquid solution to ease off in the final stages.

 

For tips about tapering individual drugs, see Important topics in the Tapering forum and FAQ

Edited by Altostrata
updated

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 3 months later...
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Summary of our harm reduction approach to tapering

 

It's best to go slowly to find out how you tolerate a reduction. Once you damage your nervous system with withdrawal symptoms, it can take a very long time to feel good again.

 

But -- many people do fine with a faster taper. Are you one of them? You can't tell. We advocate a harm reduction approach to tapering:

 

  • Initially, make a 10% reduction and hold there for a MONTH. It can take several weeks for withdrawal symptoms to emerge. Do that again the second month.
  • If you have very minor or no symptoms from these 2 reductions, you can try reducing by 10% (calculated on the last dosage) every 3 weeks. Do that twice. If no problems, reduce by 10% every 2 weeks. Do that twice.
  • If no problems after 4.5 months of very gradual reduction, you may be able to reduce by 10% every week.
  • If significant withdrawal symptoms appear, make smaller cuts or go slower. Listen to your body.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 4 months later...

Hello

 

I am not new to tapering.

I have been tapering valium for the last few years.

 

I only understand tapering in the context of a benzo.

Are the mechanisms of action the same for tapering an AD or an AP?

 

I want to see if the process of tapering seroquel and trazodone is the same as tapering benzos.(tapering each drug separately of course and not while tapering benzo)

 

I know different receptors are involved for each drug.

 

We taper benzos in two ways. One is to cut no more than 10% of the dose and hold for as long as it takes to stabilise from that cut. (In most cases a few weeks)7

Benzos can be cut daily. A daily cut is decided upon by the user, if symptoms emerge then the cut-size is reduced. The daily taper is gentler because there is no sudden lopping off of a chunk and no sudden surge of symptoms because of this.

The goal is to re-up regulate the GABA receptors so that they can begin working again, after having stopped working properly from benzo use.

 

In tapering antidepressants, is it the same? Is the goal to re-upregulate the dopamine receptos?

In tapering antipsychotics, is the goal to re-upregulate the dopamine receptors?

 

In benzo tapering, the hold time is 2-3 weeks, why is it a month in antidepressant and antipsychotics?

 

Has anyone tried micro-tapering these meds?

 

Thanks

pregan taper 600mg down to 240mg, daily cuts since xmas

valium, just over 75mg, tapering 0.1 a day, will keep this more udated, cos amounts going down

i have borderline personality, chronic ptsd, and suspected adhd and substance misuse as a symptom, which i am addressing with help of medical staff, drugs agencies & mh sta

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Great questions!

 

Yes, the tapering principle is the same for non-benzo psych meds. Try a 10% taper, hold for a month (because withdrawal symptoms might take several weeks to emerge). It all goes well, another 10% taper for a month. If you're tolerating the 10% cuts well, you might go faster, making cuts every 3 weeks or 2 weeks.

 

If you have trouble with the first or second 10% cut, you know you have to go slower, with smaller cuts.

 

Yes, people do microtaper once they've found out what their tolerance and symptom pattern is.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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I am a bit confused though and I have another question please.

 

The valium I am on has a 200hr long half life and this is why symptoms can take 2 - 3 weeks to show.

 

My trazodone only has a 3-9 hour half life and my seroquel has an half life of 6 hours (parent compound); 12 hours (active metabolite)

Why would it take several weeks for symptoms to show?

 

thanks

 

I don't know how benzos affect the brain, but what happens with the antidepressants that affect serotonin levels is that they actually change the structure of the brain, destroying some neurotransmitters and growing new ones, which creates abnormal brain functioning. When the drug is discontinued, it may take weeks for the brain to attempt to get back to normal, a process which can result in the strange and uncomfortable symptoms we call withdrawal. This is why it's so important to taper off antidepressants very slowly instead of yanking that chemical support of the nervous system away abruptly, and it's why withdrawal symptoms continue long after the AD is out of one's system. The brain takes its good old time getting back to normal.

 

Restoring brain function isn't a linear process. It seems to go in jerks forward and back, although a bit more forward overall and it can take months to years depending on the person's overall health and drug history. At this point, no one knows who is likely to suffer from protracted withdrawal and who can cold turkey with no harm done, so it's best to taper very gradually and slowly rather than take a chance on being miserable and disabled from withdrawal.

Psychotropic drug history: Pristiq 50 mg. (mid-September 2010 through February 2011), Remeron (mid-September 2010 through January 2011), Lexapro 10 mg. (mid-February 2011 through mid-December 2011), Lorazepam (Ativan) 1 mg. as needed mid-September 2010 through early March 2012

"Never attribute to malice that which is adequately explained by stupidity." -Hanlon's Razor


Introduction: http://survivingantidepressants.org/index.php?/topic/1588-introducing-jemima/

 

Success Story: http://survivingantidepressants.org/index.php?/topic/6263-success-jemima-survives-lexapro-and-dr-dickhead-too/

Please note that I am not a medical professional and my advice is based on personal experience, reading, and anecdotal information posted by other sufferers.

 

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primrose, you get withdrawal symptoms when your nervous system "notices" the absence of the drug.

 

From the same drug, some people experience withdrawal symptoms immediately and some don't. Sometimes your nervous system "notices" but doesn't send up obvious alarms right away. This can be some time later than your last dose, even weeks or months as some people have found.

 

Half-life means half the drug has been metabolized, as measured in the bloodstream. Smaller amounts of the drugs actually hang around longer than the half-life; this is usually estimated as 5 half-lives (and still a tiny amount remains, as it's a geometrical progression).

 

Some drugs have active metabolites which extend the effect with their own half-lives, which you also have to multiply by at least 5.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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There's no special way to taper each class of drugs. For tips about tapering individual drugs, see Important topics in the Tapering forum and FAQ

 

There is a wide range of reactions to decreasing dosage. Some people can cold turkey with no problem. Others do fine with a taper of a few weeks. Medicine's assumption is that most people can go off drugs that quickly.

 

However, you can't predict whether you'll be in the lucky majority or unlucky minority. To be safe -- and not inconvenience the majority too much -- we suggest a 10% reduction and holding for a month at least twice to catch most withdrawal problems.

 

Peter Breggin established the 10% rate through trial and error, and peer support groups have confirmed it is a safe rate.

 

Only the most sensitive people should have problems with this trial taper, and they'll know it within the 2 months.

 

People who report withdrawal symptoms after some number of months invariably have not tapered at 10%. This is not a well-known technique.

 

Sometimes people have withdrawal symptoms within a couple of months but don't recognize them, they think it's something else, stress or the flu. Doctors will tell them they don't have withdrawal symptoms. After a while, the symptoms culminate and, after a little (or a lot of) research, they realize they have withdrawal syndrome.

 

So the 10% trial reduction for 2 months is a way to test whether it's too fast, too slow, or just right for you.

Edited by Altostrata
updated

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 3 weeks later...

How do you define obsessive thinking, primrose?

 

I agree that one of the challenges is maintaining a balance between vigilance and obsessive overanalysis.

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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  • 4 months later...
  • Administrator

For gradual tapering, many medications come in liquid forms or can be made into liquids http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

 

The reduction continues at 10% on the last dose even down to fractions of a milligram. It is asymptotic, approaching but never equaling zero. When to jump off is an individual judgment call based on your symptom pattern. If you get withdrawal symptoms at every decrease, no matter how small, you will want to cut the last bit even finer (and hold more frequently).

 

For safety, depending on sensitivity to reductions (you can tell what your symptom pattern is), an individual may quit somewhere less than 1 milligram for antidepressants, which are generally dosed in the hundreds of milligrams.

 

Tapering other drugs dosed in the tens of milligrams or single digits (Abilify, benzos, etc.) involves decreases of hundredths of a milligram and may end at a tiny fraction of a milligram.

Edited by Altostrata
fixed text and updated

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 3 months later...
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Hi, floronet.

 

The same guidelines apply to benzos.

 

We're not experts in benzo tapering here. There are sites that specialize in going off benzos. You may wish to join this Facebook group

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 11 months later...

Question-

 

Can you take existing pills to a compounding pharmacy and ask them to make it into a liquid? Say if I have 90 days worth of pills, can I take them there and ask them?

med exp since 1985- abilify, latuda, Seroquel, risperadol, zyprexa, Haldol. latuda, saphris, mellaril, thorazine, lithium, tegretol, Depakote, lamictal, Prozac, pamelor, wellbutrin, Ativan, klonipin, etc.

 currently only on remeron: 3/13/14-6/5/14- 15mg

6/20/14 -9.5mg < 0.75-1.5 per week

7/12/14-3.75mg

8/11/14- 0.6mg of Remeron (almost off)

8/16/14--last dose of remeron...now completely drug free....

11/21/14-- 95 DAYS DRUG FREE!!!!

 

I do not give out medical advice only personal experience.

dx: BPI, II, CKD, secondary hyperparathyroidism, Chronic pain, fibro,

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No, you need a prescription telling the pharmacy what to do.

 

The pharmacy might sell you a liquid base, though.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 2 months later...

Just a quick question - is it common for people to require a longer tapering period than the time spent on the drug in the first instance?

 

For example - someone was on, say, paroxetine at 20mg for 2 months. Would they generally be more likely to get away with a 2 month taper rather than a 2 year taper? Just seems like if someone was on a drug for a couple of months then a 10% taper would just habituate their body to the drug even further?

Slowly getting better from multiple drug changes. Holding at 20mg fluoxetine, 150mg pregabalin, 3.75mg mirtazapine until I work through some personal issues.

 

 

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Unfortunately, anyone on a drug for more than a month is at risk for withdrawal syndrome.

 

Yes, you might well spend more time tapering off a drug than you spent on it at full dosage. The risk in going faster is that you might suffer full-on withdrawal syndrome even though you consider yourself a lightweight drug user.

 

The time spent tapering does not habituate your nervous system, it lets it accommodate gradually to decreasing dosages.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 2 months later...
  • Moderator Emeritus

This is all a process that DOES take time and more time than any of us want to take but there is plenty of hope.

 

The decades thing is a real possibility for many of us but because tapering is non linear ( somewhat unpredictable) there is always the possibility of slipping in a slightly faster taper based on your symptoms.

 

You may discover, for example, that one of your drugs would be ok to taper during the SAD season. Maybe not one year but during another. There is always that possibility. 

 

The unpredictability of this tapering business can also work in your favor. Just a ray of hope.

 

RU

Fall 1995 xanax, zoloft. switched to Serzone

1996- spring 2003serzone/ xanax/ lightbox.

b]Fall 2003- Fall 2004? Lexapro 10 mg. Light box /4 mg. xanax.[/b]

2004 - Fall of 2009 10 mg Lex, 150 mg Wellbutrin XL % 4 mg xanax

November 2009- Sept. 2011 10 mg lex., 300 Well. XL, 4 mg Xanax [/b

Sept.2012- July 2012 20 mg Lex 300 Well. XL, 4 mg Xanax

My mantra " go slow & with the flow "

3/2/13.. Began equal dosing 5 Xs /day xanax, while simultaneously incorporating a 2.5 % drop ( from 3.5 mg/day to 3.4 mg/day)

4/6/13 dropped from 300 mg. Wellbutrin XL to 150 mg. Difficult but DONE! Down to 3.3 mg xanax/ day / 6/10/13 3 mg xanax/day; 7/15/2013 2.88mg xanax/day.

10/ 1/2013...... 2.5 mg xanax… ( switched to tablets again) WOO HOO!!!!!! Holding here… cont. with Lexapro.

1/ 2/2014.. tapered to 18mg ( by weight) of a 26 mg ( by weight) pill of 20 mg tab. lexapro. goal is 13mg (by weight OR 10 mg by ingredient content) and STOPPED. Feeling very down with unbalanced, unpredictable WD symptoms.

1/2/2014- ??? Taking a brain-healing break from tapering anything after actively tapering something for 1.5 years. So… daily doses as of 2/2/2014: 18 mg by weight Lex, 150 mg Well. XL, 2.5 mg xanax, down from 26 mg by weight Lex., 300 mg well. XL, 4 mg xanax in August, 2012. I'll take it. :) 5/8/14 started equivalent dose liquid./ tabs. 5/13/14 1.5 % cut.

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And as you get down with your drugs and doses you will feel better and better.  You will have your life back long before you

are off them completely. Don't give up chick, keep going and you will get there.

 

 

 

This is very true & so is everything else I've read here from MamaP.  

 

That is another huge ray of hope for you right now. You WILL feel better as you successfully lower your doses. Sometimes that can actually be a problem because it is tempting to speed up.

 

But in the beginning I too was skeptical, felt defeated & pretty hopeless... so I get it.

 

I actively tapered not last winter but the winter before and did ok. Last winter I decided to take a break and I'm glad that I did.

 

What will happen this winter remains to be seen. 

 

One has to take every little step that you take forward, including just realizing the drugs are negatively impacting you as a huge victory. Because every LITTLE step forward IS a huge victory.  

 

AND  a step backward can be viewed as a victory as well because with every step backward you have gained just a little more insight, a little more knowledge, your body has given you just one more clue as how to best approach the continuation of YOUR taper.

 

Your brain is your friend, not your enemy. I have HATED and hate mine often enough but I have come to terms with the fact that what I desire ( to get off of the drugs .. NOW because I feel better & better at lower doses) and what i NEED frequently aren't in sync. 

 

It's a little like tug of war:  sometimes you have to give in a little and brace yourself so that you can take a little plus some to gain ground. 

 

Hang in there and listen to MammaP... she knows of which she speaks!!!

 

RU :)

Fall 1995 xanax, zoloft. switched to Serzone

1996- spring 2003serzone/ xanax/ lightbox.

b]Fall 2003- Fall 2004? Lexapro 10 mg. Light box /4 mg. xanax.[/b]

2004 - Fall of 2009 10 mg Lex, 150 mg Wellbutrin XL % 4 mg xanax

November 2009- Sept. 2011 10 mg lex., 300 Well. XL, 4 mg Xanax [/b

Sept.2012- July 2012 20 mg Lex 300 Well. XL, 4 mg Xanax

My mantra " go slow & with the flow "

3/2/13.. Began equal dosing 5 Xs /day xanax, while simultaneously incorporating a 2.5 % drop ( from 3.5 mg/day to 3.4 mg/day)

4/6/13 dropped from 300 mg. Wellbutrin XL to 150 mg. Difficult but DONE! Down to 3.3 mg xanax/ day / 6/10/13 3 mg xanax/day; 7/15/2013 2.88mg xanax/day.

10/ 1/2013...... 2.5 mg xanax… ( switched to tablets again) WOO HOO!!!!!! Holding here… cont. with Lexapro.

1/ 2/2014.. tapered to 18mg ( by weight) of a 26 mg ( by weight) pill of 20 mg tab. lexapro. goal is 13mg (by weight OR 10 mg by ingredient content) and STOPPED. Feeling very down with unbalanced, unpredictable WD symptoms.

1/2/2014- ??? Taking a brain-healing break from tapering anything after actively tapering something for 1.5 years. So… daily doses as of 2/2/2014: 18 mg by weight Lex, 150 mg Well. XL, 2.5 mg xanax, down from 26 mg by weight Lex., 300 mg well. XL, 4 mg xanax in August, 2012. I'll take it. :) 5/8/14 started equivalent dose liquid./ tabs. 5/13/14 1.5 % cut.

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  • 2 months later...

This 10% tapering every 4-6weeks got me from 20mg to my present dosage which is 10mg.

 

This is the only way to get off anti d's.

 

Best advice ever.

 

Remember SLOW is the key.

 

Doctors never told me about the 10% rule.

 

They told me to cut the tablets in half and get off a drug that i had been on for years within a month. Lmao!

 

That didnt work out to good. So finding out about the 10% taper was amazing.

Brief seroxat history:

20mg April 1997

0mg Summer 1998

30mg October 1999

20mg October 2002 -July 2011

20mg -5.2mg July 2011 - August 2012

Crashed at 5.2mg August 2012

10mg present date. Stable :-)

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  • 6 months later...
  • Administrator

If you've been on the drug for a month or more, you are still at risk for withdrawal syndrome.

 

Severe life-threatening adverse reactions call for a faster taper. Extreme adverse reactions justify cold turkey, though it may still take a long time to recover from withdrawal.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 1 month later...

Just found this, an updated paper from Dr. Healy on stopping antidepressants. Not sure why it's not listed as a link through his site. It came up in google search.

 

Here he is more specific in that he mentions the 10% approach, and alludes to the waves and windows of withdrawal. You may want to add this to your list of links in the why taper by 10% thread. 

 

https://rxisk.org/gu...How_to_withdraw

Edited by ChessieCat
fixed link

2005-2008: Effexor; 1/2008 Tapered 3 months, then quit. 7/2008-2009 Reinstated Effexor (crying spells at start of new job.)
2009-3/2013: Switched to Pristiq 50 mg then 100 mg
3/2013: Switched to Lexapro 10mg. Cut down to 5 mg. CT for 2 weeks then reinstated for 6 weeks
8/2013-8/2014: Tapering Lexapro (Lots of withdrawal symptoms)
11/2014 -8/2015: Developed severe insomnia and uncontrollable daily crying spells
12/2014-6/2015: Tried Ambien, Klonopin, Ativan, Lunesta, Sonata, Trazadone, Seroquel, Rameron, Gabapentin - Developed Anxiety disorder, PTSD, and Psychogenic Myoclonus
7/2015-1/2016: Reinstated Lexapro 2 mg (mild improvement, but crying spells still present)

1/2016-5/2017: Lexapro 5 mg ( helped a lot, but poor stress tolerance & depressive episodes)

5/20/2017 - Raised dose to Lexapro 10 mg due to lingering depression(Total of 2 failed tapers & severe PAWS)

9/11/2018 - Present: Still on 10 mg Lexapro and mostly recovered.(Anxiety still triggers Myoclonus.)

10/7/2022 - 20 mg Lexapro (brand only) Plus occasional Klonopin for anxiety and Ambien for insomnia.

 

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  • 2 months later...

I understand a lot of people on here are currently in the "Storm" of WD - some have CT'd , while others have tapered too fast but are still on their "Drugs".  The one clear thing seems that everyone eventually gets better. 

 

So once your stable on a certain dosage and you have given your CNS time to recover - can the remainder of your Tapering process be done as a background thing in your life with little effect on your day to day functioning? If done slow enough that is. . . 

Started Citalopram in 2005 (aged 15) for apparent "OCD" - 60mg 

July 2015 attempted 2 x 10% + cuts 4 weeks apart. WD symptoms intense at times. Need to slow down.

 

November 2016 - Resumed taper. 1.25 - 1.5% decrease weekly approx.

44.5mg November 2016. Jan 2017 42.5 mg. March 2017 40 mg. June 2017 37mg. September 2018 22mg. Nov 2018 Holding at 22mg to stabilise from moderate wave. January 2020 - Holding, mostly feeling fine, but still having some waves at times. 

 

February 2020 - Resumed taper , 1.5% reduction weekly/every two weeks. 

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Hi Nick,

 

I think this is the ultimate goal and the reason why this site exists.  To inform and support us to come off the best way for our own brain/body and live our lives as we do.

 

The best way is to give our brains time to reconstruct backwards which is why 10% or slower tapering is recommended, with holds in between to allow our brains to adapt to the change.  Patience, listening to our bodies for signs that our brain is healing/reconstructing and holding.

 

I don't think there will ever be the perfect way to come off drugs as we don't live in a perfect situation and we have to deal with external influences over which we sometimes have little or no control, but we can make the choice about how we let them affect us, ie positivity.

 

I found these very helpful in understanding what is happening which in turn is helping me to accept and be patient:

 

Video:  Healing from Antidepressants: Patterns of Recovery

 

Brain Remodelling

 

And a description which is more detailed but easy to understand:  Best Description of Healing Process

 

CC

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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There's me - my tapering is getting further and further into the background of my life.  In Feb of this year I thought I'd never leave my house again (due to severe adverse-effects from Effexor), and now I'm gardening again, visiting friends, going into town - even drove myself into Hamilton yesterday.  I'm having family here for Christmas, and thinking of joining a local trauma-response team. 

 

This has all happened since I found a low tapering amount - 0.4% weekly for four weeks, then a month's hold.  I may be able to increase that slightly over time, after plenty of settled time.   

2010  Fluoxetine 20mg.  2011  Escitalopram 20mg.  2013 Tapered badly and destabilised CNS.  Effexor 150mg. 

2015 Begin using info at SurvivingAntidepressants.  Cut 10% - bad w/d 2 months, held 1 month. 

Micro-tapering: four weekly 0.4% cuts, hold 4 weeks (struggling with symptoms).

8 month hold.

2017 Micro-tapering: four weekly 1% cuts, hold 4 weeks (symptoms almost non-existent).

2020 Still micro-tapering. Just over 2/3 of the way off effexor. Minimal symptoms, - and sleeping well.
Supplements: Fish oil, vitamin C, iron, oat-straw tea, nettle tea.

2023 Now on 7 micro-beads of Effexor. Minimal symptoms but much more time needed between drops.

 'The possibility of renewal exists so long as life exists.'  Dr Gabor Mate.

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  • 4 weeks later...
  • Administrator

I'm sorry, Dr. Glenmullen has removed most of his files from the Web.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 1 month later...

It's me again. I have a question about the holds between the reductions. I have read quite a lot of materials here on SA, but for some reason this has not become 100% clear for me. I hope you don't mind my question.

Here we go (this is a hypothetical scenario):

 

If you make a reduction and let's say within a few days develop wd symptoms that you perhaps rate 6-7 points in intensity. Let's say you have already tried reducing several times once a month and you know the pattern of your symptoms. My question is: how long would you actually have to wait for the next reduction to be on the safe side? Should you expect the intensity of the symptoms to go back to 0 or is this utopical to expect in many cases? If 0 is not what you should be aiming for before you reduce again - what is it? 1-2? 4?

 

 

My question is derived from the "harm reduction" way of starting a taper Alto has described in this topic. It says that you should move your reduction up by a week if the symptoms are minor. I guess I'm also asking what that "minor" means.

  • 2,5 years of slowly tapering down Cymbalta from 60 mg. Then tried going from 8,44 mg to 1 mg in 8 days. (April 1st 2015). That's when the real hell started. Reinstated. Didn't help. I was added Ativan (2 mg 2 times a day for relentless akathisia that started with jumping Cymbalta). For years had been taking Zopitin 7,5 mg and Stilnox 10 mg for I had not been able to sleep naturally since the 1st day I started Cymbalta). Used to take Xanax occasionally.
  • All of the above were stopped cold turkey when I was hospitalized in the beginning of May 2015.
  • Prior to that I have been on and off the whole spectrum of different AD-s for 15 years (since I was 17).

My introduction.

 

Tapering:

  • Olanzapine (starting point 2,1 mg): Jan 2016  /---/ April 2018 0 mg. (From 2,1 mg to 0 mg in 1y 3mo).
  • Diazepam (starting at 5 mg) : switching to liquid May 2018;  4,6 mg (June 2018) /---/ 0 mg (Feb 2020) (From 10 to 5 - nobody knows, from 5 to 0 in 1 y 10 mo)
  • Valdoxan (starting at 25 mg): switching to liquid (Feb 2019) /---/ 0 mg (July 2020)

 

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If you are getting severe withdrawal reactions lasting more than a few days after a reduction, your reductions are TOO LARGE. You should make smaller reductions.

 

It's possible you can make smaller reductions more often than every month, but you'll have to see what your symptom pattern is like over 3-4 reductions.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 7 months later...

I've just finished reading The Soft Landing Method by Benjamin Kramer. He recommends a taper of 1/2 of original dose for first three months. Then 1/4 of original dose second three months. Then 1/8 of original dose for third three months. He says that it takes three months for your brain to adapt.

 

Prior to reading this book, I've been following posted recommendations of a 10% taper. It can get confusing.

 

 

Thoughts?

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That advice from Benjamin Kramer's The Soft Landing Method is better than most.

 

Many people cannot handle the larger decreases he suggests. With those decreases, you may very well feel withdrawal for 3 months or longer. The taper we recommend gets you to more or less the same place, but more gradually. It is intended to produce minimal withdrawal symptoms, and take less time for your nervous system to adapt to each small change.

 

Many of the people posting on this site came here after they tapered too quickly or went cold turkey and started searching the Web for explanations of their symptoms. They started out with withdrawal syndrome problems. Once Humpty Dumpty falls off the wall, it's hard to put him together again, and these people may continue to have drug-related symptoms for quite a while.

 

We have many people who have done well with their tapers, but they have less reason to post continuously. And, tens of thousands of people read the topics in our Tapering forum and don't register here or post at all.

 

If you want to go off psychiatric drugs, the only way is to reduce the dosage one way or the other. The only questions are "How?" and "At what rate?" The 10% per month rate we espouse is intended to serve everyone, including those who are very sensitive to dosage decreases (in addition, a very small number of hypersensitive people find they need to taper even slower).

 

We acknowledge that there is a wide variation of tolerance for tapering. The taper should be tailored to the tolerance of the individual. If you are tapering, learned your symptom pattern, and want to go a bit faster, you might try reductions of 10% every 3 weeks instead of 4 weeks and, after a while, every 2 weeks instead of 3 weeks.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Apologies for not seeing this before:

 

I have a bit of a complicated question...

 

Lengthening my taper plan by doing 10% or lesser drops also means more and more years on this awful poison. 9 more years from today is a LONG time... how do I know if the benefits of being on this longer and going at a snails pace means less damage on my brain and body than getting off sooner but not as slow?? A little conflicted about this. Would LOVE some advice.

 

The 10% per month taper schedule is intended to minimize withdrawal symptoms. Some people are very sensitive to reductions in dosage.

 

Withdrawal symptoms are not things you can just brush off, they're signals from your nervous system that something isn't right. It is possible to trigger withdrawal symptoms that are severe and last for years.

 

So the question is: Which is more important: To get off the drug quickly, or to minimize withdrawal symptoms?

 

Some people are taking drugs in dangerous combinations or are causing health problems. If you are having a serious adverse effect from a drug, such as liver damage, you may choose to go off sooner rather than later. The risk of withdrawal syndrome may be about equal to or even less than the health risk of taking the drug.

 

If you are not having a serious adverse effect, which would show up in blood tests or other physical tests, the risk of withdrawal syndrome is greater than the health risk of the drug. You would want to avoid withdrawal syndrome with gradual tapering.

 

There is no one-size-fits-all answer. Since the factors leading to a decision about tapering are individual, these questions are best asked and answered in your Introductions topic, where we can see much of your recent history.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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nz, your calculations are correct. I have revised post #1 to say

 

  • "Jump off" at the end when you are taking less than 98% of the original dose and reductions no longer cause any reaction at all.

Under this method, the fastest taper takes about 12 months.

 

 

We cannot predict the jumping-off point, it's highly individual. To be safe, many people stop when the dosage is so low, they cannot divide the drug any further.

 

If you're using a liquid to taper, this can be 0.01 milligram (one-hundredth milligram).

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • Altostrata changed the title to Why taper by 10% of my dosage?
  • 2 weeks later...

Hey - I'd like to understand what the evidence is behind some of the comments in the OP.  I don't mean to be confrontational, my goal here is to be cordial. :-) 

 

 

Quote

The reason this site exists is because doctors are unaware of the greater safety of gradual dosage reduction, usually advise tapers that are too fast, do not sufficiently recognize withdrawal syndrome, and do not know what to do if it occurs.

2


What is the evidence of greater safety in gradual dose reduction?  


 

Quote

If you get prolonged withdrawal syndrome, there is no known treatment or cure. You will have to cope with it until it goes away.

 

Quote

 

It's a Humpty-Dumpty situation. Once your nervous system falls off that wall, there's not much that can be done to put it together again.


 

 
Quote

 

Once you damage your nervous system with withdrawal symptoms, it can take a very long time to feel good again.


 


What is the evidence for this?  Many people on these drugs had psychological issues before ever taking the meds (which is what led them to take the meds in the first place).  Particularly if they have been on the meds for a few years, how does one differentiate what is withdraw, and what is the original baseline issues?  

 

Thanks in advance!! :-)
 

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Would you like to start an Introductory Thread, Glyph? That may be the way to go to introduce yourself and also ask any other questions that you may have. 

Welcome.

Many SSRI's and SSNRI's over 20 years. Zoloft for 7 years followed by Effexor, Lexapro, Prozac, Cymbalta, Celexa, Pristiq, Valdoxan, Mianserin and more - on and off. No tapering. Cold turkey off Valdoxan - end of May 2014

 

                                                  Psych Drug - free since May 2014
.
         

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40 minutes ago, AliG said:

Would you like to start an Introductory Thread, Glyph? That may be the way to go to introduce yourself and also ask any other questions that you may have. 

Welcome.

 

Thanks for the offer :-) For now I am not trying to get into specifics of my situation. (which I am aware should go in a separate thread)  For now I would just like to understand the evidence behind some of the statements in the OP.  (Which I think qualifies for being posted to this thread.  Thanks!

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Hi, Glyph.

 

I would be fascinated to find out about your own personal experience with psychiatric medication and your motives for joining Surviving Antidepressants. I'm assuming that you are here because you are either considering withdrawing from these drugs or have already done so and have run into difficulties. However, we cannot understand your perspective until you tell us a bit more about yourself. For this reason we ask everyone who joins to start an introductory thread.

 

The first post in this topic has links to some well respected organisations and individuals that advocate a gradual reduction to prevent the disabling symptoms that can accompany drug withdrawal. There is also a wealth of information and resources provided by The Council for Evidence Based Psychiatry

 

We have a whole section devoted to journals and scientific papers that form the basis of our evidence for this condition. These papers have been peer reviewed and may ease some of your concerns about the validity of the statements you referenced.

Journals and Scientific Sources

 

Quote

What is the evidence for this?  Many people on these drugs had psychological issues before ever taking the meds (which is what led them to take the meds in the first place).  Particularly if they have been on the meds for a few years, how does one differentiate what is withdraw, and what is the original baseline issues?

 

Whilst it is true that some people have unresolved psychological issues that may resurface and will need to be addressed. It is also true that there are others who were prescribed antidepressants, antipsychotics and benzodiazepines for conditions unrelated to mental health. They had no baseline issues. We have members who were given psychiatric medications, off-label, to treat conditions such as chronic pain, insomnia and migraines. These people had no history of psychiatric illness, but subsequently developed severe withdrawal symptoms whilst trying to come off these medications. Theirs and many other personal testimonies can be found in the introductions and updates forum. 

Edited by Dan998

2001: 20mg paroxetine
2003-2014: Switched between 20mg citalopram and 10mg escitalopram with several failed CT's
2015: Jan/ Feb-very fast taper off citalopram; Mar/ Apr-crashed; 23 Apr-reinstated 5mg; 05 May-updosed to 10mg; 15 Jul-started taper; Aug-9.0mg; Sep-8.1mg; Oct-7.6mg; Nov-6.8mg; Dec-6.2mg
2016: Jan-5.7mg; Feb-5.2mg; Mar-5.0mg;  Apr-4.5mg; May-4.05mg; Jun-3.65mg; Jul-3.3mg; Aug-2.95mg; 04Sep-2.65mg; 25Sep-2.4mg; 23Oct-2.15mg; 13Nov-1.95mg; 04Dec-1.75mg; 25Dec-1.55mg.
2017: 08Jan-1.4mg; 22Jan-1.25mg; 12Feb-1.1mg; 26Feb-1.0mg; 05Mar-0.9mg; 15Mar-0.8mg; 22Mar-0.7mg; 02Apr-0.6; 09Apr-0.5mg; 16Apr-0.4mg; 23Apr-0.3; 03May-0.2mg; 10May-0.1mg

Finished taper 17 May 2017.

Read my success story

 

I am not a medical professional. The information I provide is not medical advice. If in doubt please consult with a qualified healthcare provider.

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On 2017-8-27 at 10:04 PM, glyph said:


What is the evidence of greater safety in gradual dose reduction?  

 Personally, I don't need any other evidence besides the fact that a gradual dose reduction for over 3 years now has given me my life back.

 

That's all the evidence I need.

 

Yes, for some people drug is not their only problem but is definitely not a solution for the hardships of being human.

 

We warn and urge people to work hard on developing non-drug ways of coping with mental distress.

Current: 9/2022 Xanax 0.08, Lexapro 2

2020 Xanax 0.26 (down from 2 mg in 2013), Lexapro 2.85 mg (down from 5 mg 2013)

Amitriptyline (tricyclic AD) and clonazepam for 3 months to treat headache in 1996 
1999. - present Xanax prn up to 3 mg.
2000-2005 Prozac CT twice, 2005-2010 Zoloft CT 3 times, 2010-2013 Escitalopram 10 mg
went from 2.5 to zero on 7 Aug 2013, bad crash 40 days after
reinstated to 5 mg Escitalopram 4Oct 2013 and holding liquid Xanax every 5 hours
28 Jan 2014 Xanax 1.9, 18 Apr  2015 1 mg,  25 June 2015 Lex 4.8, 6 Aug Lexapro 4.6, 1 Jan 2016 0.64  Xanax     9 month hold

24 Sept 2016 4.5 Lex, 17 Oct 4.4 Lex (Nov 0.63 Xanax, Dec 0.625 Xanax), 1 Jan 2017 4.3 Lex, 24 Jan 4.2, 5 Feb 4.1, 24 Mar 4 mg, 10 Apr 3.9 mg, May 3.85, June 3.8, July 3.75, 22 July 3.7, 15 Aug 3.65, 17 Sept 3.6, 1 Jan 2018 3.55, 19 Jan 3.5, 16 Mar 3.4, 14 Apr 3.3, 23 May 3.2, 16 June 3.15, 15 Jul 3.1, 31 Jul 3, 21 Aug 2.9 26 Sept 2.85, 14 Nov Xan 0.61, 1 Dec 0.59, 19 Dec 0.58, 4 Jan 0.565, 6 Feb 0.55, 20 Feb 0.535, 1 Mar 0.505, 10 Mar 0.475, 14 Mar 0.45, 4 Apr 0.415, 13 Apr 0.37, 21 Apr 0.33, 29 Apr 0.29, 10 May 0.27, 17 May 0.25, 28 May 0.22, 19 June 0.22, 21 Jun updose to 0.24, 24 Jun updose to 0.26

Supplements: Omega 3 + Vit E, Vit C, D, magnesium, Taurine, probiotic 

I'm not a medical professional. Any advice I give is based on my own experience and reading. 

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Thanks for the responses - @Dan998 I posted an introductory as requested - hope fully that clarifies a bit more about myself.  (As requested at the top of this thread " detailed discussion of YOUR particular circumstances will take it off track and make this topic difficult for others to follow" - so I didn't want to muddy this thread with my personal details. 

 

You mentioned that the OP has links to well-respected organizations.  Which organizations do you consider well respected?  NHS is well respected... I'd be curious if NHS actually makes statements that are in line with the ones I quoted.   (i.e. like the humpty dumpty quote)

 

Text does not convey tone unfortunately.  So please don't take my questions as being combative, I am just asking matter of factly :-) Im curious and want to get to the truth.  I think there is a fine line between diligent vigilance and unhealthy obsession and fear.  I do have some worry that the way some of the statements in the OP are stated, it could easily make someone suffering from anxiety and/or benzo withdraw to go into the obsession/fear side of things.  

 

In any case - what I am looking for is studies that backup statements like the humpty dumpty one.   My hope is that some of the guru's on this forum could help me identify some empirical evidence to back up those specific quotes.  Lists of studies that may or may not be related leave me with the job of spending hours sifting through to try to find what specific evidence backs up those specific claims.  Since the OP went to all the trouble to compile the info originally, my hope is that they have some idea of what study, or what well-respected organization backs up some of the more extreme claims like the humpty dumpty one. :-)  It would save me loads of time, and help convince me if I could see that evidence.  

 

Apologies if I seem skeptical.... I am skeptical.... but in a friendly way!!  I hope you all can understand.  The OP says the reason this forum exists because "doctors are unaware".  So this forum is based around skepticism of doctors.  I hope then you can tolerate someone who is skeptical of doctors but also skeptical of what I see online. :-)

 

Here is one example of what makes me particularly skeptical here. 

 

In the OP it mentions "From reports of withdrawal syndrome all over the Web, those concerned about withdrawal syndrome have come to a consensus:"

 

This sort of statement for me makes me question if the content is based on empirical evidence or based on educated guesses.... not that educated guessing is meaningless, but it is known to be very flawed due to our well studied cognitive biases. :-)  So I think one has to be very careful about "coming to a consensus" about anecdotal reports online. 

 

 

 

 

 

 

 

 

 

 

bias2.png

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