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


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  • 10 months later...

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.

diagnosed with MDD/GAD nov 2013, 6 months following CMV complications post-kidney transplant.  lst zyprexa taper 12 months; /increased paxil to 30 mg; crash nov 2014 w/ suicidal ideation & 10day hospitalization.  2nd zyprexa taper 6 months; crash after 6 weeks; reinstated zyprexa 15mg in 6/15 (both tapers worked well to the 2.5mg dose).  3rd zyprexa taper ... 17mg 3 mos;  15mg 1 mo; 10mg 3 mos, 5 mg 3 mos. 2.5mg caused some decompensating, so back to 3mg and  the 10% redux.  UPDATE: moved to FL in late 2016. found great new psychiatrist who agrees that hubby taking too many meds.  continued zyprexa taper and finally  jumped off at .5mg in 2018.  had terrible insomnia. added seroquel @ 300 mg and then tapered 10% to 12.5mg over 2 years. everything was great until it wasnt; hubby suddenly got very agitated and manic.  hospitalized 2x in early 2020 for "idiopathic secondary mania" and diagnosed as bipolar.  seroquel now back @ 100mg plus depakote @ 2500 mg and trazadone @ 100mg. 

mirtazapine 30 mg 45mg 15mg

ativan .5mg 1x/day, occasionally .5 addl  if needed for sleep 3x/day n now 1x/day

paxil 20 mg 1x/day 

gabapentin 1200 - 1800 mg 2 -3 x/day

immunosuppressive drugs for kidney transplant: sirolimus, tacrolimus, mycophenalate, prednisone, levothyroxin and a whole handful of others

 

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  • Administrator

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

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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  • 5 months later...

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.

On Zoloft 200 mg for 16 yrs. Lamictal 100-150 mg for 14 yrs. A few times I've lowered the dose of Zoloft from 200 mg to 175 or 150 mg for a day or 2. At 175 mg I have decreased focus/concentration within the same day. From 200mg to 150 mg, some sadness and slight confusion. 2 days at 150mg, shorter attention span, less patience, frustrated easily. I've never tried a slow, long term taper. My only experience being off meds completely has been unintentional, "cold turkey" cessation because I forgot to take them that day or forgot to order refill on time and ran out. Withdrawals start less than 4 hours off regular doses, cold turkey. Symptoms: Very hard to retrieve info and express thoughts succinctly. Circumstantial speech. Lose patience with people. If refill is delayed for several days, by day 2, I start to overeat, eat sweets late at night, oversleep, late to work. Day 2 to day 3, a gradual increase of morbid obsessive thoughts, wrenching guilt for any mistake, suicidal ideation. Day 3, I see the world through a watery lense. Nothing is clear or sharp. Night of day 4 off meds cold turkey - Panic attacks, crying, spikes of suicidal ideation. Day 5, Brain feels like a hard ball jostling around when I turn my head. I lose train of thought, lose sense of direction, get lost easily. I shower but no energy for grooming. Can't get myself together to get anywhere on time. Increasingly convinced my life is worthless. The symptoms completely remit within 2 hours after restarting meds. Never completely off meds longer than 5 days in the past 16 yrs.

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  • Administrator

Good points, Carousel. Thank you.

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...

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

2011 I was put on Bupropion xl 150 mg, Venlafaxine xr 150 mg, & Zopiclone 7.5 mg & increased my Clonazepam from one pill once a day @ 0.5 to 3 pills a day @ 0.5, I tried going off Bupropion cold turkey a few years back and it caused severe depression, with suicidal thoughts & major flu like symptoms so I had to go back on it within 3 days.  I then tried going down from 150mg to 112.5mg dose of Venlafaxine 3 weeks back and had brain zaps for two weeks & dizziness with it. The first week I had major flu like symptoms, however my blurry vision improved with just one dose lower, and all the other symptoms have cleared, I did have one crying spell and felt like I did not want to face the world that day. I cannot go lower @ 80mg, I go into severe depression, suicidal, nightmares, sick to my stomach.  

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  • 11 months later...
  • Administrator

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

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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  • 8 months later...

Really valuable info—thanks!

Long history with many psych drugs beginning in 1987. Went through two too-fast Paxil withdrawals in the past. Ended up in ER both times. I successfully got off Wellbutrin, and (occasional only) Seroquel, Concerta, and Klonopin over six months. Current supplements: multivitamin, probiotic, D3, magnesium, CBD. Current drugs: Ranitidine 300 mg. for acid reflux, Paxil (tapering off).

 

Paxil Taper History, 2018/2019

Jan.1: 60 mg. May 1: 55 mg. May 13: 50 mg. June 3: 47.5 mg. June 14: 45 mg. June 21: 42.5 mg. July 5: 40 mg. Switched to figuring by weight. 40 mg. = .704 July 22: .686. July 29: .669. August 5: .652. August 12: .635. September 2: 30 mg. October 2: 25 mg. November 2: 22 mg. December 1: 20 mg. January 6: 18 mg. Now using a digital scale and an emery board to taper. January 16: I decided to go back on the drugs after a year of tapering. I’m more depressed than ever, and do not believe it’s withdrawal. Thank you, everyone, for your support, advice, and kindness. Centime.

 

 

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  • 4 months later...

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❤️

Jill28

march - June 19, 2018- Zoloft

August 22, 2018- August 24, 2018- Prozac

August 24 to current- clonazepam - still reducing from .25 twice a day.

August 24 to Sept 24th - Cyproheptadine 2mg

August 29- End of November Lunesta 3 mg

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  • 1 month later...
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! 🤗

Currently taking Ramapril (blood pressure) 5 mg twice a day

Omeprazole 10 mg AM and 20 mg PM  (the taper has gone nowhere after the first cut)

Famotidine   once a day (and I still needs tums sometimes)

magnesium 200 mg at night

as of yesterday 2 fish oil capsules "EPA-DHA 1000"

 

off Lexapro as of 5/2018  - last dose had been 5 mg every other day for a couple years

 

highest dose had been 20 mg at which point I was diagnosed with Bipolar II, which went away when I cut the lexapro down to 15 mg. 

 

I spent years on Paxil before Lexapro (can't remember dose), briefly on Effexor and Abilify and others I have forgotten. in fact, when I was diagnoses with BPII I was put on all kinds of things which made me feel so bad I stopped them cold turkey within maybe 3 or 4 weeks, thank goodness. since then I've known these pills were terrible and I weaned down the Lexapro with zero help or support over I'm not sure how many years. 

 

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  • 1 month later...

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 

2016 10mg Lexipro

2014 2mg kpin

2012 10mg Trazodone 

Tapered to 1mg of kpin over 3 months 2018. Holding there until I get off the SSRI'S 

Tapered 3 weeks from 10mg to 5mg of lexipro then from 5mg to 0mg December 8, 2018.

Dec 2018 Currently holding on .5mg 2x a day of Kpin and 5mg of Trazdone at night.  No lexipro

Jan 2019 Dropped to .25 2x per day of Kpin

Supplement Update  Feb 2019 - Fish Oil, B Complex, Magnesium, Lions Mane

Feb 14, 2019 Dropped to .25 1x per day of kpin

Feb 19, 2019 Last dose of kpin.  

Feb 20 SSRI and Benzo Free

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  • 1 year later...
  • 1 month later...

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.

1980s: First diagnosed with depression. Treated with a tricyclic. 1988: Switched to Prozac 20 mg.  1990s to 2010: On and off Prozac. Increased dose led to side effects. 2011: Put on Zyprexa. 2011: Work burnout and breakdown. Hospitalized for suicidal depression. Switched to Seroquel. Switched to Celexa 40 mg and lithium 300 mg. 2019: Stopped Seroquel. 

2020 July: Decreased Celexa to 30 mg in attempt to alleviate sexual dysfunction. Worked somewhat.

2020 August: Decreased Celexa to 20 mg. Sexual function improved but w/d effects started. 

2020 September: Maintaining Celexa at 20 mg. Experiencing w/d effects - fatigue, dysphoria, mood instability

2020 September 13: Increased Celexa to 30 mg due to w/d effects. Still on lithium 300 mg/day.

2020 October 3: Reduced Celexa to 27 mg. Started taper. 10% per month as recommended.

2020 October 18: Reduced to 24 mg.

2020 December 4: Reduced to 21 mg.

2020 December 23: Reduced to 20 mg (spacing out taper intervals due to persistent w/d effects)

2021 September 23: Several reductions over the past 9 months to 7.0 mg. Stressful life circumstances led me to feeling very depressed with suicidal feelings, so upped to the dose to 10 mg until I feel better. 

 

 

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  • 2 months later...
  • Moderator Emeritus

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. 

Please do not private message me.  Only tag me for urgent questions about tapering and reinstating - thank you.  

 

***Please note this is not medical advice.  Discuss any decisions about your medical care with a doctor who understands psych meds and how to withdraw from them, if you can find one.

 

Lexapro   Started Apr 15 2010 - 10 mg;  started taper August 2017, recent taper info: Apr 2 '20  0.18 mg; Jul 16  0.17 mg, Aug 23  0.16 mg, Oct 7  0.15 mg, Nov 8 - 0.14, Jan 16 '21 - 0.13, Feb 7 - 0.12, Feb 22 - 0.11, Mar 26 - 0.10, May 21 - 0.09, June 15 - 0.08 Aug 16 - 0.07, Oct 6 - 0.06, Nov 21 0.05, Dec. 17 0.04, Jan 14 '22 0.03, Feb 19 0.02, Apr 18 0.01, May 15 0.005,  Jul 8, 0.00.  Psych Drug Free as of July 8, 2022!!  Woohoo!!!

other meds: Levothyroxine 75 mg

magnesium in small amounts at 4 AM, before bed

suppl AM: fish oil, flax oil, vit C, vit E, multivitamin, zinc

suppl 8 PM: magnesium 350 mg, extended release vitamin C, melatonin 2 mg

 

Paxil 2002 - 2010, switched to Lexapro 2010 

Trazodone 50 mg. 2002 - 2019, fast tapered in 2019 

Xanax 0.5 mg as needed 2002 - 2019, up to 3x weekly 

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  • 3 months later...

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

Example:

2013- 2021 Celexa 30 mg

March 2021 Taper Celexa but not succesful

July 2022 Cross taper Sertraline

September 2022 Cross taper Lexapro

October 2022 Cross taper Celexa 20 mg. Fast taper clonazepam

November 2022 Taper Celexa from 20 mg to 15 mg. Lorazepam 2.5 mg

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  • Moderator
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 : )

Remeron - 2004-2005 (bad withdrawal)

Clonazepam - 2005-2018 (jumped around March)

Olanzapine - 2014- late 2017

Domperidone - 2008-2018

Many drugs in between including Lexapro, other benzos and z-drugs.

Still suffering post-withdrawal from Clonazepam (Klonopin), Olanzapine and Domperidone. 

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  • 1 month later...

i wish i saw this a long time ago

2019 (poor taper jump off celexa 20mg to 10mg in 1week and xanax 1mg to .5 and jumped.

 relapsed onto Ativan 1mg per day and Effexor 150xr i think i maxed out at 225mg
2020:
tapered off Effexor April-September
tapered Ativan from late Sept-Oct
tapered Nov2-14 on Valium, JUMPED Nov 15 2020

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  • 1 year later...

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.

2010-2015 Cipramil 20-40mg. half-year break in the middle which was tough.

2015-2020 Venlafaxine 150-225 mg. Venlafaxine duloxetine cross taper details 

150 for half-year then 225 for a period than stabilized in ~187.5 (1.25 pills) for 2 years than reduced to ~168.5 (1.125 pills).

3.2020 - Duloxetine 60mg.

19.05.2020 - started to taper - 59! 20.5 - 58.5. June 2020: 57. end of June - 55.5

Summer 2020: 5.7 - 54, 9.7 - 52, 12.7 - updose to 53+, 19.7 - 52.3, 26.7 - 51.8, 4.8 51.3, 11.8 - 50.8, 15.8 - updose to 51.0, 17.8 - 50.5, 19.8 - 50.3, 19.9 - 49.3

Autumn-winter: 7.10 - 46.8, 1.12 - 45.8, 17.12 - 44.4, 30.12 - 42.4, 21.1 - 40.8. 17.2 - 40.1, end of feb - 38.6,

springmid march updose to 40.1, 28.3 - 38.6, 15.4 - 37.5, 14.5 - 36.8, end of may 37.5+ and after a week 39

Summer 2021:  mid of june again to 36.7, end of july 39.5.

11.10.2021 - 40.7 📌

 

 

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  • 6 months later...

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

From 2018 and current

escitalopram 10 mg twice daily, lamotrigine 25mg twice daily, effexor 75 mg twice daily, risperidone 0.75 mg at night and 0.5 mg in morning and clonazepam 0.25 night and 0.125 morning daily

 

November 2022

Tapered off 0.125 mg clonazepam morning dose

 

As of january 16 2023

escitalopram 10 mg twice daily, lamotrigine 25mg twice daily, effexor 75 mg twice daily, risperidone 0.75 mg at night and 0.5 mg ( currently tapering)in morning and clonazepam 0.25 night 

 

As of September 2023
escitalopram 10 mg twice daily, lamotrigine 25mg twice daily, effexor 75 mg twice daily, risperidone 0.75 mg at night and 0.25 mg in morning(cutrently tapering ) and clonazepam 0.25 night

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  • 8 months later...

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.

~1992-2015 Paroxetine, on and off a few times, fast tapers.

-2015-2019 Sertraline 50 mg to 100 mg & back down, 2 month taper and off October 2019.

-2020 mid January 25 mg Sertraline for 1 week, insomnia so stopped.
-2020 mid February - mid June 25 mg Sertraline steady and ~1.5 to 3.75 mg Mirtazapine on and off from a few days to a couple of weeks at a time with 1 to 2 week breaks.

-2020 June 24 to present - off Mirtazapine totally, 25 mg Sertraline taken every morning.

-April-July 7, 2022, 15 mg Hydroxyzine, stopped cold turkey.  Still on 25 mg sertraline.

-January 2023 started 20 mg Omeprazole (a ppi). -March 1-31, 2023 tapered off Omeprazole. -May 1, 2023 back on Omeprazole. -July 1-31, 2023 tapered off Omeprazole. -Sept 29, 2023 back on 20 mg Omeprazole.

-Oct 29, 2023 started 670 mg ashwaghandha.

-Nov 3,  2023, increased Sertraline to 50 mg,

 

 

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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

 

From 2018 and current

escitalopram 10 mg twice daily, lamotrigine 25mg twice daily, effexor 75 mg twice daily, risperidone 0.75 mg at night and 0.5 mg in morning and clonazepam 0.25 night and 0.125 morning daily

 

November 2022

Tapered off 0.125 mg clonazepam morning dose

 

As of january 16 2023

escitalopram 10 mg twice daily, lamotrigine 25mg twice daily, effexor 75 mg twice daily, risperidone 0.75 mg at night and 0.5 mg ( currently tapering)in morning and clonazepam 0.25 night 

 

As of September 2023
escitalopram 10 mg twice daily, lamotrigine 25mg twice daily, effexor 75 mg twice daily, risperidone 0.75 mg at night and 0.25 mg in morning(cutrently tapering ) and clonazepam 0.25 night

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  • 4 months later...

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

 

 

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