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Why taper by 10% of my dosage?


Altostrata

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  • Moderator Emeritus

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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  • Moderator Emeritus

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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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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  • 1 month later...
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 Aug 4, 2017 - 25 mg;  Jan 1, 2018 - 12.5 mg;  Jan 16, 2019 - 2.6 mg;  Jan 5, 2020 - 1.0 mg;  Jan 3, 2021 - 0.27 Current dose:   July 18 - 0.00

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  • Moderator Emeritus
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

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

Plodding along inch by inch:  12" = 1',  3' =  36 " or 1 yard,  1760 yards  = 63,360" or 1 mile

Current from July 2021:  Pristiq 0.11mg

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 Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

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

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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 Aug 4, 2017 - 25 mg;  Jan 1, 2018 - 12.5 mg;  Jan 16, 2019 - 2.6 mg;  Jan 5, 2020 - 1.0 mg;  Jan 3, 2021 - 0.27 Current dose:   July 18 - 0.00

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  • 2 months later...
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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  • 1 month later...
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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 am not a doctor. My posts are not medical advice.CYP450 interactions | drug.com interactions

Red means updose.

Abilify: 34.46mg 26Apr20; 32.71mg 18May20; 31.75mg 13Jun20; 30.48mg 22Jun20; 29.56mg 28Jun20; 28.96mg 30Jul20; 28.09mg 20Aug20; 27.44mg 28Sep20; 26.80mg 20Oct20; 26.17mg 22Oct20; 25.53mg 28Oct20; 26.17mg 30Oct2026.81mg 4Nov2026.01mg 7Dec20, 26.81mg 13Dec20,  26.97mg 3Jan21,  27.29mg 25Jan21, 26.65mg 30Jan21, 26.01mg 28Feb21, 25.69mg 8Mar21, 25.85mg 10Mar21 25.53mg 18Mar21,  25.21mg 28Mar21,  25.37mg 29Mar21,  25.53mg 30Mar2125.21mg 16Apr21

Paxil: Took it from Oct2019 to 15Apr20 with max dose 40mg. Lots of uneducated ups and downs (of the dosage) during that time. Then switched to Lexapro.

Lexapro: Started with 15mg on 15Apr20. 18.54mg 28Jun20. Tapered to current dose (16.58mg) until 5Nov20

Tolperisone: tolperisone 300mg

Biperiden: 2.7mg 1Jun20; 2.6mg 26May21; 2.5mg 31May21; 2.38mg 18Jun21; 2.11mg 4Jul21

Supplements: chelated magnesium 400mg (+100g pumpkin seeds), low-dose b-complex, melatonin

 

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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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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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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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  • 1 month later...

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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  • 5 months later...
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getofflex

Here is a brief and easy to understand (nontechnical) article about why it's important to taper hyperbolically.  

 

Why Taper Hyperbolically

***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 '02 - 10 mg;  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

Benadryl 50 mg, Ibuprofen 800 mg, or Tylenol 1000 mg

other meds: Levothyroxine 75 mg

suppl AM: fish oil, flax oil, vit C, vit E, calcium

suppl PM: magnesium 350 mg, GABA 750 mg, Estroven, melatonin 2.5 mg

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  • 2 weeks later...
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Yesyes123

Up until how long after a 10% dose reduction could someone still suffer from WD in the lower dose? Could someone for example, lower the dose and actually feel better for a few weeks and then be hit after like a month with WD symptoms on this lower dose?

July 2015 - Started Escitalopram 10mg (Lexapro) at age 15. Took it everyday until July 2020 (5 Years)

July 2020 - Turned 21 started tapering off until August (TOO FAST TAPER/ ALMOST SAME AS COLD TURKEY)

August 2020 -  Clear Manic episode (nothing absurd or life threatening)

September 2020 - Start feeling a bit weird

October 2020 - Crashed. The absolute worst time of my life. 

Late October 2020 - Reinstated Escitalopram 10mg. Perscribed Antipsychotics (Lithium, Seroquel) REFUSED

Early November 2020 - Psychiatrist wrongly upped the dosage to 15mg. Still taking 15mg / day as of today. 

 

22 January 2021: 

Beginning to stabilize on 15mg/day Escitalopram (Lexapro) 🧠

Taking 25mg Magnesium Citrate 4x per day / 2000mg Vitamin C Prolonged Release + Kiwis + Fresh Fruit / Salmon everyday for Omega3 Fatty Acids

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ChessieCat
1 hour ago, Yesyes123 said:

Up until how long after a 10% dose reduction could someone still suffer from WD in the lower dose? Could someone for example, lower the dose and actually feel better for a few weeks and then be hit after like a month with WD symptoms on this lower dose?

 

This might happen, if nothing else has changed, if a drug has reached tolerance, also known as poop out or tachyphylaxis, which can happen after a person has been taking a drug for an extended time and it loses its effectiveness.  When this happens the doctor may increase the dose and the person starts to feel improvement then after some more time the same thing happens.  See:

 

tolerance-or-poop-out-or-tachyphylaxis

 

and

 

Tachyphylaxis, Reaching Tolerance or as It's Lovingly Known “Poop-Out”

 

Generally withdrawal symptoms after a reduction show up during the first 1 or 2 weeks after the dose is lowered and then they start to reduce.  Tolerance to a drug generally happens gradually over time and one sign that it is tolerance might be that when a reduction is made a person starts to feel better but the longer they hold then the symptoms start to worsen.

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

Plodding along inch by inch:  12" = 1',  3' =  36 " or 1 yard,  1760 yards  = 63,360" or 1 mile

Current from July 2021:  Pristiq 0.11mg

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 Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

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

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Yesyes123

Thanks @ChessieCat,

 

How can it be that a person will feel better after a dose reduction if they have reached tolerance? Wouldn't they need more of the drug in order to get that mood improvement?

 

Or is it a paradoxical effect, like when a person will CT and feel great for a while (maybe even manic) before crashing into severe WD?

July 2015 - Started Escitalopram 10mg (Lexapro) at age 15. Took it everyday until July 2020 (5 Years)

July 2020 - Turned 21 started tapering off until August (TOO FAST TAPER/ ALMOST SAME AS COLD TURKEY)

August 2020 -  Clear Manic episode (nothing absurd or life threatening)

September 2020 - Start feeling a bit weird

October 2020 - Crashed. The absolute worst time of my life. 

Late October 2020 - Reinstated Escitalopram 10mg. Perscribed Antipsychotics (Lithium, Seroquel) REFUSED

Early November 2020 - Psychiatrist wrongly upped the dosage to 15mg. Still taking 15mg / day as of today. 

 

22 January 2021: 

Beginning to stabilize on 15mg/day Escitalopram (Lexapro) 🧠

Taking 25mg Magnesium Citrate 4x per day / 2000mg Vitamin C Prolonged Release + Kiwis + Fresh Fruit / Salmon everyday for Omega3 Fatty Acids

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ChessieCat

Please read the links I provided and ask questions in this topic:

 

tolerance-or-poop-out-or-tachyphylaxis

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

Plodding along inch by inch:  12" = 1',  3' =  36 " or 1 yard,  1760 yards  = 63,360" or 1 mile

Current from July 2021:  Pristiq 0.11mg

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 Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

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

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Yesyes123
12 minutes ago, ChessieCat said:

Please read the links I provided and ask questions in this topic:

 

tolerance-or-poop-out-or-tachyphylaxis

 Thanks, will do!

July 2015 - Started Escitalopram 10mg (Lexapro) at age 15. Took it everyday until July 2020 (5 Years)

July 2020 - Turned 21 started tapering off until August (TOO FAST TAPER/ ALMOST SAME AS COLD TURKEY)

August 2020 -  Clear Manic episode (nothing absurd or life threatening)

September 2020 - Start feeling a bit weird

October 2020 - Crashed. The absolute worst time of my life. 

Late October 2020 - Reinstated Escitalopram 10mg. Perscribed Antipsychotics (Lithium, Seroquel) REFUSED

Early November 2020 - Psychiatrist wrongly upped the dosage to 15mg. Still taking 15mg / day as of today. 

 

22 January 2021: 

Beginning to stabilize on 15mg/day Escitalopram (Lexapro) 🧠

Taking 25mg Magnesium Citrate 4x per day / 2000mg Vitamin C Prolonged Release + Kiwis + Fresh Fruit / Salmon everyday for Omega3 Fatty Acids

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Yesyes123

How does weight/ metabolism speed affect tapering? I have a fast metabolism and am a bit underweight, even on Lexapro. I wonder what that means for my tapering.

July 2015 - Started Escitalopram 10mg (Lexapro) at age 15. Took it everyday until July 2020 (5 Years)

July 2020 - Turned 21 started tapering off until August (TOO FAST TAPER/ ALMOST SAME AS COLD TURKEY)

August 2020 -  Clear Manic episode (nothing absurd or life threatening)

September 2020 - Start feeling a bit weird

October 2020 - Crashed. The absolute worst time of my life. 

Late October 2020 - Reinstated Escitalopram 10mg. Perscribed Antipsychotics (Lithium, Seroquel) REFUSED

Early November 2020 - Psychiatrist wrongly upped the dosage to 15mg. Still taking 15mg / day as of today. 

 

22 January 2021: 

Beginning to stabilize on 15mg/day Escitalopram (Lexapro) 🧠

Taking 25mg Magnesium Citrate 4x per day / 2000mg Vitamin C Prolonged Release + Kiwis + Fresh Fruit / Salmon everyday for Omega3 Fatty Acids

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  • Moderator Emeritus
ChessieCat

The 10% every 4 weeks is a GUIDELINE, not a rule.  Just like every other member on SA listen to your symptoms and taper at a rate which keeps symptoms to a minimum, holding for longer as needed.  There may be some doses during a taper that a member might have more difficulty getting past.  This is an observation, and there is no "rule" for which drug and dose this applies to because there are so many variables and we are all an experiment where N=1.

 

If you keep notes on paper for yourself (and you can also rate your symptoms) you may be better able to see how the taper rate and hold is affected and whether you need to reduce less/hold longer.  Faster metabolisers may need to split their dose, but that is more likely for drugs with a shorter half life than Lexapro.  Lexapro has a fairly long half life.

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

Plodding along inch by inch:  12" = 1',  3' =  36 " or 1 yard,  1760 yards  = 63,360" or 1 mile

Current from July 2021:  Pristiq 0.11mg

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 Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

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

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Yesyes123

Thank you very much @ChessieCat hope you are well

July 2015 - Started Escitalopram 10mg (Lexapro) at age 15. Took it everyday until July 2020 (5 Years)

July 2020 - Turned 21 started tapering off until August (TOO FAST TAPER/ ALMOST SAME AS COLD TURKEY)

August 2020 -  Clear Manic episode (nothing absurd or life threatening)

September 2020 - Start feeling a bit weird

October 2020 - Crashed. The absolute worst time of my life. 

Late October 2020 - Reinstated Escitalopram 10mg. Perscribed Antipsychotics (Lithium, Seroquel) REFUSED

Early November 2020 - Psychiatrist wrongly upped the dosage to 15mg. Still taking 15mg / day as of today. 

 

22 January 2021: 

Beginning to stabilize on 15mg/day Escitalopram (Lexapro) 🧠

Taking 25mg Magnesium Citrate 4x per day / 2000mg Vitamin C Prolonged Release + Kiwis + Fresh Fruit / Salmon everyday for Omega3 Fatty Acids

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  • 2 weeks later...
Fallensoul

Would it be usefull in any case with drugs with short halftimes, when reaching small dosises, to split the intake into two times a day, instead of one to prevent low and teep more steady serum value's? Would this helps a bit with withdrawal?

 

 

1998-2020  Paroxetine 20mg, stopped working 2018/08 tapered down to 6mg now @ 1%/week 2019 /04      Lorazepam 3x1mg, 1x0,5mg night, Lormetazepam 0,5mg night
2019/05       Buspirone addition 3x5mg worked like wonders for one month, stopped ct 2019/12        Mirtazipine, first 2x10mg til 2021/2, no effect, now 3mg for sleep
2020/06       Wellbutrin 6 weeks, no effect stopped ct 2020/08 Lexapro, trying, to crossover, got crazy from 1 mg/day after 6 days, stopped
2020/11        Clomipramine to 50mg, adverse effect, restless, panic, low mood, anxiety, fast taper down to 30 (plan is go to ~20 and hold and taper only parox. and benzo's and maybe Mirt if I sleep)

2021/1         3x1000mg gaba, 3x10mg Lithium Orotate, 3x 1000mg L-Tyrosine,2-3 times 1x400mg magnesium citrate , 2-3 times 1x1000mg vit. C,1x15mg Zinc,

                     3 times 2mg Molybdeen Glycinate, 2 times 2000mg Omgea 3-6-9 and 1x16mg B6 (P5P) 2021/03/17  Gaba, Tyrosine and Lithium orotate to 3x1 tablet.

2021/03/17   Cl 30, P 5,8. 2021/03/20 Cl 28. 2021/03/23 M 2,7. 2021/03/25 M 2,6, Cl 26, P 5,7. 2021/03/28 Cl 25. 2021/04/1 P 5,6. 2021/04/07 Cl 24,P 5,5. 2021/04/08 Cl 23,5. 2021/04/13 P5,4

2021/03/26  Lor 3x0,9, 1x0,45 night, Lorm 0,45night 2021/04/13 CL 23, M 2,5. 2021/04/16 Cl 22,5, P 5,3. 2021/04/18 M 2,4. 2021/04/24 Cl 22. 2021/04/29 M2,3, P5,28. 2021/05/8 Cl 21,5.

2021/05/9   M 2,2, P 5,22. 2021/05/12 Cl back to 22, 2021/05/20 Lor 3x0,8, night 1x0,40 Lorm 1x0,40 2021/05/27 Cl 20(holding)2021/05/28 P5,15 (holding)2021/05/31 Cl 22 (holding)

2021/06/7   Lor 3x0,75 1x0,38 night, Lorm 0,38night 2021/11/7 P5

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ChessieCat
6 hours ago, Fallensoul said:

Would it be usefull in any case with drugs with short halftimes, when reaching small dosises, to split the intake into two times a day

 

Yes, if a drug has a half life of less than 24 hours then it may be helpful to split the dose.  Cymbalta is a drug with a 12 hour half life and needs to be taken twice daily regardless of tapering.  If a person is a fast metaboliser and takes a drug that has a half life of about 24 hours or a bit more they might need to split their dose.

 

Keeping daily symptoms notes for yourself can help you to see a pattern.  If you are experiencing interdose withdrawal you will notice a distinct pattern.  Symptoms will ease at about the same time each day when the last dose taken starts to work.  And as it wears off you will notice the symptoms increasing.

 

Sometimes a person will be taking a drug which is extended release and for tapering purposes changes to an immediate release tablet.  If a person needs to crush the tablet or make a liquid from the tablet, then it may be better to split the doses.

 

SA generally suggests moving part of the dose by 1 hour each day and observe your symptoms, noticing if your sleep is being affected.  ADs are generally activating.  It important to try not to disrupt your sleep.

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

Plodding along inch by inch:  12" = 1',  3' =  36 " or 1 yard,  1760 yards  = 63,360" or 1 mile

Current from July 2021:  Pristiq 0.11mg

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 Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

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

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  • 1 month later...
gdsequoia

<math nerd hat on> :)

I'd like to point out that the "reduce by 10% of the current dose per month" rule (advocated by SA.org) yields an exponential curve (0.9^x) and not a hyperbolic one (such as 1/x).

Example:
SA's rule: 1.0, 0.9, 0.81, 0.729, 0.6561...
Hyperbolic: 1.0, 0.5, 0.3333, 0.25, 0.2...

I am not a doctor. My posts are not medical advice.CYP450 interactions | drug.com interactions

Red means updose.

Abilify: 34.46mg 26Apr20; 32.71mg 18May20; 31.75mg 13Jun20; 30.48mg 22Jun20; 29.56mg 28Jun20; 28.96mg 30Jul20; 28.09mg 20Aug20; 27.44mg 28Sep20; 26.80mg 20Oct20; 26.17mg 22Oct20; 25.53mg 28Oct20; 26.17mg 30Oct2026.81mg 4Nov2026.01mg 7Dec20, 26.81mg 13Dec20,  26.97mg 3Jan21,  27.29mg 25Jan21, 26.65mg 30Jan21, 26.01mg 28Feb21, 25.69mg 8Mar21, 25.85mg 10Mar21 25.53mg 18Mar21,  25.21mg 28Mar21,  25.37mg 29Mar21,  25.53mg 30Mar2125.21mg 16Apr21

Paxil: Took it from Oct2019 to 15Apr20 with max dose 40mg. Lots of uneducated ups and downs (of the dosage) during that time. Then switched to Lexapro.

Lexapro: Started with 15mg on 15Apr20. 18.54mg 28Jun20. Tapered to current dose (16.58mg) until 5Nov20

Tolperisone: tolperisone 300mg

Biperiden: 2.7mg 1Jun20; 2.6mg 26May21; 2.5mg 31May21; 2.38mg 18Jun21; 2.11mg 4Jul21

Supplements: chelated magnesium 400mg (+100g pumpkin seeds), low-dose b-complex, melatonin

 

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Yesyes123
11 hours ago, gdsequoia said:

<math nerd hat on> :)

I'd like to point out that the "reduce by 10% of the current dose per month" rule (advocated by SA.org) yields an exponential curve (0.9^x) and not a hyperbolic one (such as 1/x).

Example:
SA's rule: 1.0, 0.9, 0.81, 0.729, 0.6561...
Hyperbolic: 1.0, 0.5, 0.3333, 0.25, 0.2...

 

That's interesting... I believe SA suggests the 10% rule to be safer for everyone. But there is research like Mark Horowitz saying that the last option is appropriate to mitigate WD symptoms. 

 

Although it still might be too fast for some.

July 2015 - Started Escitalopram 10mg (Lexapro) at age 15. Took it everyday until July 2020 (5 Years)

July 2020 - Turned 21 started tapering off until August (TOO FAST TAPER/ ALMOST SAME AS COLD TURKEY)

August 2020 -  Clear Manic episode (nothing absurd or life threatening)

September 2020 - Start feeling a bit weird

October 2020 - Crashed. The absolute worst time of my life. 

Late October 2020 - Reinstated Escitalopram 10mg. Perscribed Antipsychotics (Lithium, Seroquel) REFUSED

Early November 2020 - Psychiatrist wrongly upped the dosage to 15mg. Still taking 15mg / day as of today. 

 

22 January 2021: 

Beginning to stabilize on 15mg/day Escitalopram (Lexapro) 🧠

Taking 25mg Magnesium Citrate 4x per day / 2000mg Vitamin C Prolonged Release + Kiwis + Fresh Fruit / Salmon everyday for Omega3 Fatty Acids

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Gridley
Posted (edited)
12 hours ago, gdsequoia said:

I'd like to point out that the "reduce by 10% of the current dose per month" rule (advocated by SA.org) yields an exponential curve (0.9^x) and not a hyperbolic one (such as 1/x).

Example:
SA's rule: 1.0, 0.9, 0.81, 0.729, 0.6561...
Hyperbolic: 1.0, 0.5, 0.3333, 0.25, 0.2...

Regardless of what it's called, SA's slower method is much safer.  This is particularly so at the lower doses.  It took me 11 months to go from 1.0mg Lexapro (the most potent SSRI on the market) to 0.0025 (at which point I jumped to zero), and the time was well spent in terms of reduced symptoms and a smooth jump to zero.

Edited by Gridley

Gridley Introduction

 

Lexapro 20 mg since 2004.  Begin Brassmonkey Slide Taper Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Oct. 30, 2020  Jump to zero from 0.025mg.  Current dose: 0.000mg

3 year, 10 month taper is 100% complete.

 

Ativan 1 mg 1986-1991 CT, soon reinstated.  CT 2000. RI 1 mg 2011-2016.  Sept. 2016  0.625mg X 3

Nov.27, 2020, 7-week Ativan-Valium crossover + change to one 18.75mg dose, w/1 month hold.

Feb. 9, 2021, begin 10% every 4 weeks taper.  Current dose as of July 13: 10.0mgai.  Taper is 46% complete.

 

Imipramine 75 mg daily since 1986.  Jan. 2016 began every 3-weeks 10% taper, down to 16mgai (44mgpw).  Aug 2016, discovered SA, holding at 16mg.  Taper is 78% complete.  

  

Supplements: omega, vitamins C, E and D3, magnesium glycinate, probiotic, zinc, melatonin .3mg.


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

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gdsequoia

I gave a bad example, sorry.

Here's a better comparison (spreadsheet I made).

I haven't read Horowitz's paper, since I have eye pain from computer screens, but I'm still posting this in the hope it may be useful to some.

 

EDIT: made spreadsheet public so you can all access it

I am not a doctor. My posts are not medical advice.CYP450 interactions | drug.com interactions

Red means updose.

Abilify: 34.46mg 26Apr20; 32.71mg 18May20; 31.75mg 13Jun20; 30.48mg 22Jun20; 29.56mg 28Jun20; 28.96mg 30Jul20; 28.09mg 20Aug20; 27.44mg 28Sep20; 26.80mg 20Oct20; 26.17mg 22Oct20; 25.53mg 28Oct20; 26.17mg 30Oct2026.81mg 4Nov2026.01mg 7Dec20, 26.81mg 13Dec20,  26.97mg 3Jan21,  27.29mg 25Jan21, 26.65mg 30Jan21, 26.01mg 28Feb21, 25.69mg 8Mar21, 25.85mg 10Mar21 25.53mg 18Mar21,  25.21mg 28Mar21,  25.37mg 29Mar21,  25.53mg 30Mar2125.21mg 16Apr21

Paxil: Took it from Oct2019 to 15Apr20 with max dose 40mg. Lots of uneducated ups and downs (of the dosage) during that time. Then switched to Lexapro.

Lexapro: Started with 15mg on 15Apr20. 18.54mg 28Jun20. Tapered to current dose (16.58mg) until 5Nov20

Tolperisone: tolperisone 300mg

Biperiden: 2.7mg 1Jun20; 2.6mg 26May21; 2.5mg 31May21; 2.38mg 18Jun21; 2.11mg 4Jul21

Supplements: chelated magnesium 400mg (+100g pumpkin seeds), low-dose b-complex, melatonin

 

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Yesyes123
On 5/19/2021 at 4:11 AM, gdsequoia said:

SA's rule: 1.0, 0.9, 0.81, 0.729, 0.6561...
Hyperbolic: 1.0, 0.5, 0.3333, 0.25, 0.2...

 

Isn't the spreadsheet a lot different than what you wrote here?

July 2015 - Started Escitalopram 10mg (Lexapro) at age 15. Took it everyday until July 2020 (5 Years)

July 2020 - Turned 21 started tapering off until August (TOO FAST TAPER/ ALMOST SAME AS COLD TURKEY)

August 2020 -  Clear Manic episode (nothing absurd or life threatening)

September 2020 - Start feeling a bit weird

October 2020 - Crashed. The absolute worst time of my life. 

Late October 2020 - Reinstated Escitalopram 10mg. Perscribed Antipsychotics (Lithium, Seroquel) REFUSED

Early November 2020 - Psychiatrist wrongly upped the dosage to 15mg. Still taking 15mg / day as of today. 

 

22 January 2021: 

Beginning to stabilize on 15mg/day Escitalopram (Lexapro) 🧠

Taking 25mg Magnesium Citrate 4x per day / 2000mg Vitamin C Prolonged Release + Kiwis + Fresh Fruit / Salmon everyday for Omega3 Fatty Acids

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gdsequoia
1 hour ago, Yesyes123 said:

Isn't the spreadsheet a lot different than what you wrote here?

Yes it is; my first example was a bad example, because it showcases a fast hyperbolic taper. But a hyperbolic taper doesn't have to be fast.

 

There is an infinite number of possible hyperbolic tapers, and an infinite number of possible exponential tapers.

 

Example of 2 different exponential tapers:

Reduction by 10% of the current dose (aka "SA's rule"): 1.0, 0.9, 0.81, 0.72, 0.65...

Reduction by 5% of the current dose (aka "what many SA members do"):  1.0, 0.95, 0.90, 0.86, 0.81...

 

Example of 2 different hyperbolic tapers:

A fast hyperbolic taper can be: 1.0, 0.5, 0.3333, 0.25, 0.2...

A slower hyperbolic taper (like in the spreadsheet) can be: 1.0, 0.89, 0.8, 0.73, 0.67...

 

Hope it's clearer now.

I am not a doctor. My posts are not medical advice.CYP450 interactions | drug.com interactions

Red means updose.

Abilify: 34.46mg 26Apr20; 32.71mg 18May20; 31.75mg 13Jun20; 30.48mg 22Jun20; 29.56mg 28Jun20; 28.96mg 30Jul20; 28.09mg 20Aug20; 27.44mg 28Sep20; 26.80mg 20Oct20; 26.17mg 22Oct20; 25.53mg 28Oct20; 26.17mg 30Oct2026.81mg 4Nov2026.01mg 7Dec20, 26.81mg 13Dec20,  26.97mg 3Jan21,  27.29mg 25Jan21, 26.65mg 30Jan21, 26.01mg 28Feb21, 25.69mg 8Mar21, 25.85mg 10Mar21 25.53mg 18Mar21,  25.21mg 28Mar21,  25.37mg 29Mar21,  25.53mg 30Mar2125.21mg 16Apr21

Paxil: Took it from Oct2019 to 15Apr20 with max dose 40mg. Lots of uneducated ups and downs (of the dosage) during that time. Then switched to Lexapro.

Lexapro: Started with 15mg on 15Apr20. 18.54mg 28Jun20. Tapered to current dose (16.58mg) until 5Nov20

Tolperisone: tolperisone 300mg

Biperiden: 2.7mg 1Jun20; 2.6mg 26May21; 2.5mg 31May21; 2.38mg 18Jun21; 2.11mg 4Jul21

Supplements: chelated magnesium 400mg (+100g pumpkin seeds), low-dose b-complex, melatonin

 

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Yesyes123

@gdsequoia how do you make the calculations for a slow hyperbolic taper?

 

I think since it's so similar to the "10% of current dose" guideline, advising a slow hyperbolic taper would only further complicate things and confuse people, as opposed to the 10% guideline being easier to measure and easier to grasp for beginners in here. 

 

I do understand there might be a word mistake on the original post because the 10% rule isn't exactly hyperbolic, but it's extremely close to it so it's not really a big deal

July 2015 - Started Escitalopram 10mg (Lexapro) at age 15. Took it everyday until July 2020 (5 Years)

July 2020 - Turned 21 started tapering off until August (TOO FAST TAPER/ ALMOST SAME AS COLD TURKEY)

August 2020 -  Clear Manic episode (nothing absurd or life threatening)

September 2020 - Start feeling a bit weird

October 2020 - Crashed. The absolute worst time of my life. 

Late October 2020 - Reinstated Escitalopram 10mg. Perscribed Antipsychotics (Lithium, Seroquel) REFUSED

Early November 2020 - Psychiatrist wrongly upped the dosage to 15mg. Still taking 15mg / day as of today. 

 

22 January 2021: 

Beginning to stabilize on 15mg/day Escitalopram (Lexapro) 🧠

Taking 25mg Magnesium Citrate 4x per day / 2000mg Vitamin C Prolonged Release + Kiwis + Fresh Fruit / Salmon everyday for Omega3 Fatty Acids

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gdsequoia
6 hours ago, Yesyes123 said:

how do you make the calculations for a slow hyperbolic taper?

The dose for the current month is:

originalDose / (currentMonth/8+1) 

 

For example, if you started your taper with dose 50mg, and you're on the third month of your taper, you should be taking 50 / (3/8+1) which equals 36mg.

 

You can change the "8" to another number, for a slower or faster hyperbolic taper.

 

6 hours ago, Yesyes123 said:

I think since it's so similar to the "10% of current dose" guideline, advising a slow hyperbolic taper would only further complicate things and confuse people, as opposed to the 10% guideline being easier to measure and easier to grasp for beginners in here. 

Yeah, I guess you're right. I will stop advocating for the hyperbolic taper (at least until I'm able to actually read the Horowitz paper! :) )

I am not a doctor. My posts are not medical advice.CYP450 interactions | drug.com interactions

Red means updose.

Abilify: 34.46mg 26Apr20; 32.71mg 18May20; 31.75mg 13Jun20; 30.48mg 22Jun20; 29.56mg 28Jun20; 28.96mg 30Jul20; 28.09mg 20Aug20; 27.44mg 28Sep20; 26.80mg 20Oct20; 26.17mg 22Oct20; 25.53mg 28Oct20; 26.17mg 30Oct2026.81mg 4Nov2026.01mg 7Dec20, 26.81mg 13Dec20,  26.97mg 3Jan21,  27.29mg 25Jan21, 26.65mg 30Jan21, 26.01mg 28Feb21, 25.69mg 8Mar21, 25.85mg 10Mar21 25.53mg 18Mar21,  25.21mg 28Mar21,  25.37mg 29Mar21,  25.53mg 30Mar2125.21mg 16Apr21

Paxil: Took it from Oct2019 to 15Apr20 with max dose 40mg. Lots of uneducated ups and downs (of the dosage) during that time. Then switched to Lexapro.

Lexapro: Started with 15mg on 15Apr20. 18.54mg 28Jun20. Tapered to current dose (16.58mg) until 5Nov20

Tolperisone: tolperisone 300mg

Biperiden: 2.7mg 1Jun20; 2.6mg 26May21; 2.5mg 31May21; 2.38mg 18Jun21; 2.11mg 4Jul21

Supplements: chelated magnesium 400mg (+100g pumpkin seeds), low-dose b-complex, melatonin

 

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Yesyes123
On 5/19/2021 at 4:11 AM, gdsequoia said:

Hyperbolic: 1.0, 0.5, 0.3333, 0.25, 0.2...

 

Horowitz actually suggests this exact rate. First reduction is half the dose, and so on...

 

So interesting, there are many other nuances to pay attention to like SERT Occupancy

July 2015 - Started Escitalopram 10mg (Lexapro) at age 15. Took it everyday until July 2020 (5 Years)

July 2020 - Turned 21 started tapering off until August (TOO FAST TAPER/ ALMOST SAME AS COLD TURKEY)

August 2020 -  Clear Manic episode (nothing absurd or life threatening)

September 2020 - Start feeling a bit weird

October 2020 - Crashed. The absolute worst time of my life. 

Late October 2020 - Reinstated Escitalopram 10mg. Perscribed Antipsychotics (Lithium, Seroquel) REFUSED

Early November 2020 - Psychiatrist wrongly upped the dosage to 15mg. Still taking 15mg / day as of today. 

 

22 January 2021: 

Beginning to stabilize on 15mg/day Escitalopram (Lexapro) 🧠

Taking 25mg Magnesium Citrate 4x per day / 2000mg Vitamin C Prolonged Release + Kiwis + Fresh Fruit / Salmon everyday for Omega3 Fatty Acids

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