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Altostrata

Why taper by 10% of my dosage?

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KarenB

The OP lists several reserach sources which people can follow up.  One of these is an NHS link.   

 

Drug companies have placed people in the position of needing to taper while providing extremely little information on how to safely do so.  For this reason people have had to learn how and where they can, sharing and creating knowledge bases.  Those who have done this work are now quite relieved to have science begin to realise there is a crisis, and start to conduct appropriate research.  That the two groups are starting to work together is also quite telling.  There was recently an overwhelming response to a large research survey.   

 

This grass-roots quality is also what allows SurvivingAntidepressants to use folk-references and word-pictures to illustrate processes alongside the usual thorough explanations.  Whatever we can do to help people understand the rationale, we will do.  The fate of  Humpty Dumpty is a great picture, as is Rhi's metaphor of a trellis and garden.  What we provide is not strictly Lancet; it is more than that.  People do not need a medical degree when they arrive here desparate for information.   

 

Recently I took Alto's work (and in particular this thread's OP) to my local doctor.  It was well-received, and I am now working with the doctors to implement suitable changes in the clinic, and also in other clinics in our region.  Doctors who are less biased and less afraid are able to see that there is a crisis, and they tend to be pleased with the harm-reduction approach.

 

Members are welcome to be skeptical, however we do not wish to repeatedly explain things we have already provided sources for, and which we have seen in action thousands of times.  People are welcome to wait for science to offer irrefutable evidence if they prefer; in the mean time we'll get on with helping people as best we can. 

 

 


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.

My story of healing:ContinuedHealing

***I am not a doctor; please do your own research and be able to take responsibility for decisions you make.*** 

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

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bubble

Also we are all volunteers here badly struggling with withdrawal and consequences of it and doing our best to support others in similar situation.

 

So we don't have time nor energy to persuade anyone of anything. We are not in the business of proving any points or convincing anyone. Our suffering is very real and we don't need any proof of it.

 

Problems you are talking about with your wife are different. She suffers with severe health anxiety so attacking us with your 'healthy scepticism' is a very misplaced attempt to solve your problem. She needs some good talk therapy to address the root cause of her issues. As you wrote yourself she has a tendency to worry about health irrespective of whether she reads something or not.

 

There is no point in logically arguing with her and proving with any amount of evidence that her anxiety is unfounded. It's not a matter of reason but some deeply seated fear and insecurity which has to  be unpacked and dealt with. All you need is a good therapist to work with her. Tapering is not her main problem.


Current: 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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nz11
15 hours ago, bubble said:

Also we are all volunteers here badly struggling with withdrawal and consequences of it and doing our best to support others in similar situation.

 

So we don't have time nor energy to persuade anyone of anything. We are not in the business of proving any points or convincing anyone. Our suffering is very real and we don't need any proof of it.

Great stuff Bubble

This was an excellent reply to someone who i felt had just walked into a war zone and wanted to start an argument and/or demanded proof about why we have to keep our heads down and take cover.


Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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Terry
On 8/5/2011 at 3:43 PM, Altostrata said:

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.
 
(Those finding that this method too slow can always speed up by making 10% reductions more often. However, if you get withdrawal symptoms, your nervous system is telling you that you are tapering too fast.)

The 10% per month reduction method is recommended by

I just looked at the tapering recommendation by Dr. Breggin.  He advocates 10% reductions based on the initial dose rather than on the last dose.  This would make the tapering time significantly less.  Your thoughts?

Tapering - Dr Breggin.jpg


2007 - 2008          Paxil and Klonopin

2008 - 2012           Mirtazapine following abrupt withdrawal from Klonopin/Paxil.  

2012                       Unsuccessful taper of mirtazapine; reinstated.     

7/2013 - 1/2014   Successfully tapered from 7.5 mg

 

7/19/17 ALPRAZOLAM 0.25 mg. - current  

                SERTRALINE  - 25 mg

Began taper Aug 4, 2017 - 25 mg;  Jan 1, 2018 - 12.5 mg;  Jan 16, 2019 - 2.6 mg;  Jan 5, 2020 - 1.0 mg;   

                Current dose:   Oct 25 - 0.37 mg;

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ChessieCat
1 hour ago, Terry said:

I just looked at the tapering recommendation by Dr. Breggin.  He advocates 10% reductions based on the initial dose rather than on the last dose.  This would make the tapering time significantly less.  Your thoughts?

 

I'd say no, and the reason is provided in this topic:  Why taper paper: dose-occupancy curves

 

The 10% every 4 weeks of previous dose ends up being a similar curve to the dose occupancy curves.

 

Alto's comment further down the 1st page of this topic Peter Breggin in Your Drug May Be Your Problem is quoted below:

 

On 11/10/2016 at 8:11 AM, Altostrata said:

You will have to ask Dr. Breggin why his taper is calculated on the original dose. It may be he didn't consider the implications of this: he never helped many people taper.

 

If you do it this way, your decreases become an ever-large proportion of your current dose. If you start at 20mg, at 4mg, a 2mg (10% of 20mg) reduction is 50% of the dosage to which your nervous system has (hopefully) adapted.

 

You might start out slow, but you speed up as you go along. We have many people here who have tried this and developed withdrawal symptoms.

 

Periodic dosage reduction of 10% calculated on the current dose is a much gentler reduction curve than the method Dr. Breggin described above.

 

Read Why taper by 10% of my dosage?

 

 

Edited by ChessieCat

Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 17 Oct 2020:  Pristiq 0.56 mg (compounded + liquid)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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Terry

Thank you ChessieCat!  Guess I'm too eager to taper, but need to be reminded to slow down.


2007 - 2008          Paxil and Klonopin

2008 - 2012           Mirtazapine following abrupt withdrawal from Klonopin/Paxil.  

2012                       Unsuccessful taper of mirtazapine; reinstated.     

7/2013 - 1/2014   Successfully tapered from 7.5 mg

 

7/19/17 ALPRAZOLAM 0.25 mg. - current  

                SERTRALINE  - 25 mg

Began taper Aug 4, 2017 - 25 mg;  Jan 1, 2018 - 12.5 mg;  Jan 16, 2019 - 2.6 mg;  Jan 5, 2020 - 1.0 mg;   

                Current dose:   Oct 25 - 0.37 mg;

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Iatrogenesis

Oh, now I understand why I thought I had misread Breggin's advice when I hadn't. In this thread you recommend tapering by 10% of the current dose and you say Peter Breggin recommends this and link to a thread

where his method is described as tapering by 10% of the original dose.


1 year risperidone, 1 year olanzapine (10 mg). attempted first withdrawal cold turkey, failed. 2 more years olanzapine, switched to abilify which was very disruptive so attempted quitting cold turkey, failed. then 4 years amisulpride at 150 mg and about 3 zoloft at 150 mg. attempted withdrawal from both in 3 weeks, failed. reinstated zoloft and bridged to olanzapine (10 mg), successfully withdrew it over 10 months. tried withdrawing zoloft over 12 months, failed. bridged to prozac, at 40 mg,  now at 12 mg.

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Iatrogenesis

Oh, sorry if this sounded brusque or like a criticism. I only wanted to point out that in that description it sounds like Breggin's method is 10% of the current dose too, which is not the case.


1 year risperidone, 1 year olanzapine (10 mg). attempted first withdrawal cold turkey, failed. 2 more years olanzapine, switched to abilify which was very disruptive so attempted quitting cold turkey, failed. then 4 years amisulpride at 150 mg and about 3 zoloft at 150 mg. attempted withdrawal from both in 3 weeks, failed. reinstated zoloft and bridged to olanzapine (10 mg), successfully withdrew it over 10 months. tried withdrawing zoloft over 12 months, failed. bridged to prozac, at 40 mg,  now at 12 mg.

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gdsequoia
Quote

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."

Could someone please explain this for a layman?

 

More specifically:

- "pharmacological relationships"

- "hyperbolic" - does he mean like f(x)=1/x maybe?

- "target"  - maybe this is a synonym for "drug" here?


I maintain a spreadsheet for SA.org - click here to view.

 

My drug interactions

 

[I’ve never taken 2 neuroleptics concurrently, or 2 antidepressants concurrently. Just 1 neuroleptic + 1 antidepressant]

  • Neuroleptics: Amisulpride 600mg (2014); back&forth between Amisulpride 500mg and Abilify 22.5mg (winter 2018/2019) finishing with Abilify; Abilify 15mg (Jul 2019); 3.75mg (23 Nov 2019); 4x3.75mg (12 Dec 2019); 5x3.75mg (10 Feb 2020); 34.46mg (26 Apr 2020); 32.71mg (18 May 2020); 31.75mg (13 Jun 2020); 30.48mg (23 Jun 2020)

  • Antidepressants: Escitalopram 30mg (2014); Paroxetine 40mg (Sep 2019); 15mg (Oct 2019); Escitalopram 7.5mg (24 Nov 2019); Paroxetine 15mg (Nov 2019); 20mg (Nov 2019); 30mg (23 Jan 2020); Escitalopram 15mg (26 Apr 2020); 18mg (12 Jun 2020)

  • Tolperisone: 450mg (Nov 2019); 300mg (18 Dec 2019); 150mg (26 Dec 2010); 300mg (26 Apr 2020)

  • Biperiden: Started in 2013. Partial history: 2mg (22 Dec 2020); 1.5mg (5 March 2020); 3mg (26 April 2020); 2.7mg (1 May 2020); 2.43mg (14 May 2020)

  • Supplements: Currently vitD3 2000 IU, chelated magnesium 300mg (+18g pumpkin seeds), probiotic (10^9 bacteria), melatonin 5mg, Sedorelax 2 tabl., 800mcg folic acid [paused], fish oil 1000mg, vitE 12mg

I am not a doctor. My posts are not medical advice. They are just my own opinions, thoughts and experiences.

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Altostrata

All drugs act this way, with a point of diminishing return where there's no additional benefit from excess dosage. The gradual hyperbolic taper can apply to any drug. (Meaning any drug with withdrawal effects.)

 

Read initial post

 


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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Superwoman
On 8/5/2011 at 4:43 PM, Altostrata said:

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

What about mild withdrawal symptoms? I understand that severe significant symptoms mean you are tapering too fast. Are some mild and manageable withdrawal symptoms expected when doing a 10% taper?  Or does the presence of any withdrawal symptoms (even mild) mean you are tapering too fast?


1993-2000: Zoloft few months CT, Prozac 1-2 yrs, Ritalin PRN

2002/2003: Wellbutrin,  Paxil 25mg FT, and Xanax PRN CT (all 3 to 6 months), Adderal 40mg, Strattera 40mg

2003- 2016: Effexor XR 75 mg to 150 mg., Strattera (2002-2008)

2017: Effexor XR 225 mg. Gabapentin 300 mg. Elavil 25 mg.

2018: (Sept.) Effexor XR 187.5 mg, Zoloft 10 mg. (OCT.) FT off Gabapentin (NOV.) FT off Elavil (DEC) FT Effexor to 150 mg.

2019: (JAN.) D/C Zoloft, added Viibryd 10mg (FEB) CT Viibryd, (MAR) Prozac bridge, Effexor xr 112.5mg, (Sept.) Effexor XR 112.5 mg + 0.4 mg (1 bead), (Oct.) Effexor XR 112.5mg, (Dec.28) start 10% taper Effexor XR 101.25 mg, 

2020: (Jan. 25) Effexor XR 91 mg., (Feb. 22) Effexor xr 82 mg., (Mar. 21) 75 mg. 

Supplements:  Vitamin D 5000 IU topical, Probiotic 6 billion CFU, Epsom salt bath 1C 2 to 3 X week, California Poppy 2 droppers, various essential oils 

https://www.survivingantidepressants.org/topic/21446-superwoman-effexor-taper/page/8/?tab=comments#comment-475779

 

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Altostrata

Very mild symptoms might last a few days. If they last longer or are more severe, they are a warning you're going too fast.


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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Andie

Here is the link to what I found on Desvenlafaxine 

 

The total daily dose required to provide 50% SERT occupancy was 24.8 mg for SEP-227162 and 14.4 mg for ODV. In vitro data suggests a ratio of 3.3:1 for binding at human SERT for SEP-227162 relative to ODV. Our study suggests a ratio of 1.7:1, highlighting the value of in vivo imaging in the drug development process.


Current Dose

0.5mcg Clonidine and 1.25 Diazepam PRN for treatment of iatrogenic hypertension. 

2010 .Prescribed Pristiq 100 mg in July by GP

2010 .Reduced to 50mg by splitting and weighing. Held at 50mg

2014. Reduced from 50-35 .Held at 35mg. 

2017. Taper from 35mg commenced using compounded Desvenlafaxine

2018. 23/06 13.5mg. 21/07  12.5mg. 25/08 11.5mg. 09/2018 10mg. 14/11 11mg (updose) 21/11 -12mg (updose)

2019. Still holding at 12mg and stuck. 

2020. January 2019 Prozac Bridge-- Prozac 2.5 to 10mg and

Pristiq 23rd Jan 6mg/ 27th Jan 5mg/ 28th Jan 3mg/ 30 Jan 0

Prozac 6th Feb 9.5mg. Vitamin D3 5000iu with K2

Magnesium Glycinate with Glycine and Passionflower  600mg 

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