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Exercise ... Do more, do less, do nothing? What worked for you?

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baquejohn

AlaskenG, you must be Shane? I saw your youtube video


Prozac january 2010 to  october 2016 dose started at 10mg and went up to 80mg

welbutrin october 2014 to october 2016 dose up to 400mg

effexor october 2015 to march 2016 150mg

geodon january 2016 to july 2016 80mg

i did a rapid taper off everything in 8 months time span from march 2016 to october 2016

drug free for 2 years and 7 months

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DaBro

Yes, doctor said I was on such a low dose it was probably having no effect so no taper needed. He was wrong. 

 

Sorry to hear you’re still struggling. We are developing infinite patience!


50 mg Sertraline Nov 2016 to Dec 2016

100 mg Sertraline Jan - March 2017

50 mg Sertraline April - June 2017

25 mg Sertraline July 2017 - Sept 2018

12.5 mg Sertraline Oct 2018

0 mg Nov 1 2018

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Cruizer

Hi DaBro, I don't normally comment on peoples threads but just saw your comment on 25mg being "such a low dose."

I would encourage you to look up the serotonin occupancy study (I have posted a link below for you). If you look at Sertraline on here you will see that at 25mg you were still in fact locking down around 70% occupancy despite 25mg of Zoloft being considered a low dose by doctors. The curves that you see on these graphs highlight why we need to taper at 10% of a previous dose and not in a linear path.

 

https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.161.5.826

 

I am happy to hear you have had good windows and these seem to be improving which is great news! I just though the above info might help explain why you have been in Withdrawal for what looks like 18 months and not to worry as is pretty understandable with how you came off these drugs. I wish you all the best on your journey to recovery


Started Sertraline (Zoloft) September 2009. 50mg then to 100mg within a week. Severe reaction straight away. Severe agitation, anxiety and depression

Moved to 150mg in November 2010 and floated between 150mg and 100mg for the next 6 years. Always felt better on lower dose.

February 2016 began tapering: 150-125mg for 4 weeks.

125mg-100mg for 4 weeks

100mg-87.5mg for 2 weeks

87.5mg-75mg for 6 weeks (this drop was ordinary for a week or so if severe symtoms)

75mg-68mg for 4 weeks

68mg-62.5mg for 2 weeks

62.5mg-56mg for 3 weeks. Had 3 weeks of basically no symptoms and then I crashed hard. It was like it all caught up with me. Went back up to 60mg and have been there since 5th August 2016.

At no stage has this medication made me feel better than I did before I was on it. I never had 95% of the symptoms I have now before I went on this poison

60mg-55mg on 28th December 2016; 55mg-50mg on 27th January 2017; 50mg-45mg on 20th March 2017; 45mg-40mg 1st June 2017; 40mg-38mg 1st July 2017; 38mg-36mg 15th July 2017; 36-34mg 31/07/17; 34mg-32mg 15/08/17; 32mg-30mg 30/08/17; 30mg-28mg 15/10/17; 28mg-27mg 30/10/17; 27mg-25mg 14/11/17; 25mg-24mg 29/11/17; 24mg-23mg 14/12/17; 23mg-22mg 29/12/17; 22mg-21mg 13/01/18; 21mg-20mg 28/01/18; 20mg-19mg 12/02/18. Held for 6 months at 19mg. 12/08/18 19mg-18mg; 10/09/18 18mg-17mg; Held for another 7 months. 17/04/19 17mg-16.5mg; 10/05/19 16.5mg-16mg; 24/05/19 16mg-15.5mg; 07/06/19 15.5mg-15mg; 21/06/19 15mg-14.5mg; 05/07/19 14.5mg-14mg; 14mg-13.5mg 19/07/19; 13.5mg-13mg 29/07/19; 13mg-12.5mg 08/08/19; 12.5mg-12mg 22/08/19; 12mg-11.5mg 05/09/19; 11.5mg-11mg 19/09/19; 11mg-10.5mg 03/10/19; 10.5mg-10mg 17/10/19; 10mg-9.5mg 31/10/19; 9.5mg-9mg 14/11/19; 9mg-8.5mg 28/11/19; 8.5mg-8mg 12/12/19; 8mg-7.5mg 26/12/19; 7.5mg-7.0mg 09/01/20; 7.0mg-6.5mg 23/01/20; 6.5mg-6.0mg 06/02/20; 6.0mg-5.5mg 20/02/20; 5.5mg-5.0mg 05/03/20; 5.0mg-4.5mg 19/03/20;

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Winner51

Hennie, I experience many of the same symptoms when I attempt exercise.  The back pain and nerve pain is so severe after exercise I eventually give up.  I’m curious, has your exercise intolerance improved since your Jan 2019 post? If so, when in your withdrawl process? If anyone with experience in this area could comment, I would be much appreciative.  I’m in my “10 month wave” and I’m feeling it but the back pain is the most frustrating. I began exercising again at the beginning of my tenth month of withdrawl not realizing this is supposed to be the worst month of withdrawl. Just looking for some hope for the future and my ability to exercise again...

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hennie86

Hi Winner51,

 

I am sure you will be able to exercise in the future. It is maybe not time for it yet but hopefully time will heal things

 

I hope I would be able to say my exercise intolerance would have got a lot of better but it hasnt.  I made again progress last winter but maybe added too much exercise (tried to increase a bit powerful yoga to increase muscle training and longer walks in the woods) and finally crashed again and have decided to keep my exercise level the same- walking, little gentle yoga movements (mostly relaxation), maybe riding a bike a bit. If I notice I have done too much I keep a break. Sometimes I have exercised more than normally but I usually pay the price. Harder exercise is in my case like loaning energy from the next days. There is a certain limit and I cant do more.

 

When I increased the exercise same old symptoms came back: feel like my muscles dont recover from exercise, muscles start to feel really stiff,wake up in the middle of the night because of adrenaline surges, feeling like my body/CNS is vibrating/tingling/agitated and usually in that point I think; now its time to keep a break. I think the increasing amount of adrenaline surges and symptoms after exercise are somekind of key understanding whats going on in my body. I read this post and I think it has lot in common with how I feel. Like I said I have been battling years with symptoms that resemble a lot of CFS. I think multiple withdrawal caused some kind of autonomic nervous system issues in my case.

https://www.hfme.org/adrenalinesurgetips.htm

I have made progress but not a lot. I can be a bit more physically active in every day life and do a bit more but not much. I also sleep a bit better if I take care of myself well.

 

Best way for me to handle wd has been doing things that lower stress and helps my CNS to recover and relax. Walking helps a lot such as different exercises that combine deep breathing and movement such as yoga and in my case it is really gentle. Harder exercise does the opposite in my case now. It is not time for it yet. I am sad because I loved exercise. Luckily walking outside cheer me up and its something even though I miss going to gym, running and so on..

 

I still taper benzos and have had to keep breaks in tapering because the symptoms have been sometimes too much. I have had issues of akathisia in the past and have again noticed symptoms of it. I try to concentrate in calming off myself instead of muscle training. Things have been more difficult in the end of my taper process.

 


2005-2009 Lexapro 10-20mg & Remeron 7,5mg: cold turkey

2010 tried Venlafaxine (month),  2014 6 days Cipro(antibiotics) adverse reaction

2011-2012 Seroquel 25mg (8 months) & 2011-2015 Lexapro 10-20mg (tapered off during 4 months)

2015-2016 (all these drugs during 9 months,did not tolerate most of them ) : tried Remeron. Tried to reinstate Lexapro 3 months after quitting it: fail. Akathisia, insomnia. Then went to hospital: Zyprexa10mg, Sodium Valproate, Temazepam(20mg), Oxazepam 30-45 mgs. switching meds: Seroquel 50-100mg, Oxazepam  30-45mg , Temazepam 20mg. Then back to Zyprexa 10mg, Temazepam20mg, doctor took me off Oxazepam fast. Then Zyprexa 20mg, Temazepam 20mg, melatonin10mg ( sometimes very rarely Valium 10 mg.) Zyprexa: cold turkey because Zyprexa 20 mg made akathisia intolerable after every dose. After it insomnia, 24/7 akathisia. Bad reactions to supplements

2016 spring daily  Valium 15mg>0mg (used for 4,5 months and during that time slowly tapered off), Temazepam 40 mg > 25 mg (tapered in 3 months)

2016 summer Temazepam 25 mg > 20 mg, melatonin 2,5 mg

2016 november Melatonin 0,5 mg, Temazepam 20 mg.  Started tapering again.

2020 march (microtapering) Temazepam 4,5 mg Supplements: probiotics, magnesium oil occasionally, melatonin 0,5 mg

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AlaskanGlacier

Still can't exercise beyond some light walking and a bit of light shooting around at bball court. Light garden work. Etc. Pushing beyond that still brings on bad akathisia, agitation, depression + anxiety, brain fog, etc. It's gotten better, but it's a slow process. Has anyone gotten it all back after years of physical suffering like that? This all started like 10 years ago with the exercise malaise because of the drugs. Sometimes it feels like there's no way I could go to the weightroom, play sports, hike or push myself hard again. Only 32 years old :(


Took Accutane in 2007 at age 19 and a severe reaction to it threw me into Psychiatry's dirty hands. Suffered through a number of c/t's, rapid tapers, drug switches, reinstatements before finally figuring out what was happening to me in 2012 after checking out of psych hospital with a prescription for Ativan and Prozac. (Went in because was unknowingly in Xanax c/t wd and dying at the time from it).

 

May 2016 - Last dose of Valium after 2 year long taper from 15mg

June 2017- Last dose of the corticosteroid Hydrocortisone after taper

July 2019- Last dose of Prozac after 2 year long taper from 30mg

 

Was on Accutane, Lexapro, Celexa, Xanax, Ativan, Prozac, Hydrocorisone, Valium, and thyroid meds when none of them were needed. Still recovering to this day and hope to be healed in the coming months, but taking it one day at a time.

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Adili13

Phew. Added 10 minutes of light jogging to my walk today and got immediately slammed by a wave right after. Seems to really activate me. I’ll have to not do that, though I used to love jogging. I’ll take a two week break from jogging and maybe give incline walking a go again, slowly increasing the time. 


2008: start Lexapro 10 mg which is quickly upped to 20 mg. 2008:2013 try at least four individual times to get off Lexapro, never get lower than 5mg, settle at 15 mg. 2015: again, attempt to get off Lexapro and get to 5 mg. After 6 months, feel i'm stabilizing but go back on a higher dose because of one stressful event. 2016: go to 20 mg from 15 mg due to work stresses, hit severe tolerance for the first time and become very suicidal. 2016-2017: try viibryd and cymbata in an attempt to feel better. Also add Lamictal 150 at some point. 2017: eventually land on paxil 37.5 and Lamictal 150. January 2018: cut paxil to 25. April-July 2018: reduce Lamictal in 50 mg increments till im off August. 2018: reduce paxil to 20 mg. december 2018: dropped Paxil to 18 mg, SEVERE CRASH. March updosed to 20 mg April 11: dropped to 19.4 mg due to akathsia (still experiencing akathsia symptoms from updose) April 20: 19 mg Paxil May 4: 18.7 Paxil July 5: 18.2 July 12: 17.8 Aug 19: 17.5 Aug 26: 17.3 Oct 20: 17.1 Nov 3: 16.9, 8/17/20: 16.6 after nine month hold, 8/24/20: 16.4, 8/31/20:16.2, 9/14/2020: 16.0, 9/21/20: 15.8

 

Medication signature.docx

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ChessieCat

merged similar topics

 


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 12 Sept 2020:  Pristiq 0.625 mg (compounded)

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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Tom37

Hi all,

 

Just wondering if there can be a delayed reaction to doing to much exercise? Assumed it would be straight away or the next day but wd is nothing normal.

 

I started increasing what I was doing and after the second time felt a little bit worse so stopped and then two or three weeks later have hit a nasty wave.

 

 


20mg Lexapro 2007

10mg Lexapro 2012

Started tapering approx (October 2017) 12 months ago  from 10mg to 9mg then 8 then 7 then 6 then 5 then 4 then 3.

Held for approx 4 to 6 weeks min on each reduction.

Hit severe symptoms (started 7th Nov) after dropping to 3mg. Dropped to 3mg approx 22nd October.

Back to 4mg (7th November) and stabilising. Current symptoms started 23rd November 

Used diazepam (2018) 10mg 10th Nov, 5mg 11th Nov, 2.5mg 12 Nov, 2mg 13th Nov.

Used diazepam 10mg 24th Nov, 7.5 25th Nov and 5mg 26th November.

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eboyd

I found that HR Zone training has been super helpful with keeping me from over doing it.  I am a fitness professional as well as someone who has been healing for the past 2 years.  I have been using MyZone.  If I stay in my lower HR Zones 1&2 then I tend to recover well and mitigate over working my nervous system.  Heavy lifting is super taxing on the nervous system so staying away from trying to PR any lifts is a good idea.  Start slow with more aerobic/metcon type workouts keeping the weights light and reps as well as movements in a range where you do not go out of zone 1/2.  Limit to 30 minutes 2-3 times per week and see how you respond.  A year ago I couldn't even pick up a 20# weight without feeling like I was going to pass out.  I now am able to work in my Zone 3 here and there.  I can lift again but my focus is on technique since I know going too heavy is not going to benefit me in anyway.  It takes time, patience, and the ability to work within your limitations and finding a way to keep you accountable to staying within those limitations.  Anyway, this has worked for me.  I hope it helps.


2002-2008 On and off Effexor XR 75mg 

2010 Effexor XR 75mg Trazadone 150mg

2012 Abilify 5mg and Buspar added increased Effexor XR 150mg quick taper after 6 months due to pregnancy.

2014 Reinstate Effexor XR 75mg increase to 150mg, 150mg Trazadone, Buspar, Abilify 5mg. Quick taper after about 1 year from Effexor, Abilify, and Buspar.

2018 Trazadone taper over 1 month

2018 Attempted Effexor reinstatement due to digestive distress 37.5 mg.  Failed 2xs after 4 days.  Gastro preacribed Elavil 2 weeks later.  Failed after 2 days.  3 days later full withdrawl.

 

 

 

 

 

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Brooke

This is a fascinating topic. I think there’s an argument to be made that ADs are a performance enhancing drug. 
 

I was a high level Crossfit athlete while medicated. In 2015, one year before getting off the drugs, I competed in the top 1% of athletes worldwide. Flash forward to 2016, off 37.5mg of Effexor XR, and I could not make it through a workout. Four years later, my capacity for high intensity fitness is nowhere where it once was. This is natural in some ways, given that once you step down it always feels like hell to get it back, but it feels like something more is going on.


My theory is that ADs numb the whole system, emotional and physical. Therefore, our tolerance for high intensity workouts actually goes up. I felt pain when I was training, sure.  But the threshold was so much higher. I could push through in ways I couldn’t almost immediately after stopping Effexor. 

I’ve run this theory by a few researchers who study muscle/exercise science. None of them know of any formal studies,  but they all agree that it makes sense. Curiouser and curiouser...


Effexor XR 37.5mg and Wellbutrin XL 150mg from age 15-30 (2001-2016). Hell withdrawal. Drug free (and happy) since 2016.

 

I am the founder Happiness Is A Skill, a weekly newsletter dedicated to helping people heal from depression by learning the skill of happiness. Join hundreds of others and subscribe here: http://learnhappy.brookesiem.com/

 

I wrote this for the The Washington Post: I spent half my life on antidepressants. Today, I'm off the medication and I feel all right.

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eboyd

I do not agree.  I have had the opposite experience...it is way worse in withdrawal, however.


2002-2008 On and off Effexor XR 75mg 

2010 Effexor XR 75mg Trazadone 150mg

2012 Abilify 5mg and Buspar added increased Effexor XR 150mg quick taper after 6 months due to pregnancy.

2014 Reinstate Effexor XR 75mg increase to 150mg, 150mg Trazadone, Buspar, Abilify 5mg. Quick taper after about 1 year from Effexor, Abilify, and Buspar.

2018 Trazadone taper over 1 month

2018 Attempted Effexor reinstatement due to digestive distress 37.5 mg.  Failed 2xs after 4 days.  Gastro preacribed Elavil 2 weeks later.  Failed after 2 days.  3 days later full withdrawl.

 

 

 

 

 

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Rapini

Aside from a few range of motion exercises to deal with muscle tightness and pain, I don't move unless I have to. I suffer from dizziness and temperature deregulation, which worsens with movement. When I must walk, I am very, very slow.


Supplements: Omega 3 Fatty Acid 800mg, Vitamin C 500mg (Timed Release), Magnesium 200mg

 

Mirtazapine 15mg - Start: June 2018 - Began Tapering by Skipping Pills March 2019 - CT April 29th 2019 - Restart May 8th 2019

 

14.5 - November 27th 2019, 14.1 - December 8th 2019, 13.8 December 20 2019, 13.5 February 22 2020, 13.2 March 1 2020, 12.9 March 7 2020, 12.7 March 24 2020, 12.4 April 11 2020, 12.1 April 22 2020, 11.8 May 4 2020, 11.5 May 10 2020, 11.2 June 14 2020, 10.9 June 21 2020, 10.6 July 5 2020, 10.3 July 11 2020, 10 August 10 2020, 9.8 August 16 2020, 9.5 August 30 2020, 9.3 September 5 2020, 9 September 12 2020

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ChessieCat
Posted (edited)

All we can do is listen to our own body.  Things can be different for it at different times as well so it's not a static thing.  We have to go with the flow and adapt as needed.

 

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 12 Sept 2020:  Pristiq 0.625 mg (compounded)

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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Nivsch
On 6/14/2011 at 11:46 PM, Razzle said:

 

Has anyone else found benefit/determent to exercise??

 

Walking outside and walking on stairs in between low to medium phase and not above do me the best.

 

High phase walking will transmit the brain there is a danger and will only conserve the stress. Thats should be avoided or done minimally.


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

July-August 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.

19.8.2020 - 50.3 📌 (current dose)

 

If you see the withdrawal not as a withdrawal but as a cross-taper of the drug with more nature, more walking, more sunlight and more self care, it will be a lot easier. 🌲🌱

🏯☀️

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manymoretodays

  

On 9/9/2020 at 11:26 PM, Chineoh said:

Over Stimulation

Hi there,

 

I have had a storied history with meds (as has everyone).

 

One thing that came about when I was taking meds (both citalopram and venlafaxine) was intense fatigue caused by overstimulation.

 

Everything I did and still do causes by senses and body to burn out.

 

I can't exercise as it essentially causes my body into overload. I get a stress rash all over my body, my heart rate stays elevated for 5+ hours after exercise and it feels terrible.

 

Relaxation techniques such as meditation and guided breathing have no effect, diet doesn't do anything. I don't drink or take drugs.

 

I have tried every type of exercise imaginable (at every pace) and it still burns me out.

 

I have had my bloods checked regularly, and have no major immune disorders.

 

It is incredibly confusing and frustrating, it feels like my tolerance for physical stress is fried.

 

Any help would be greatly appreciated.

 

Thank you.

 

Chineoh's signature:

2008-2013 - 10mg Citalopram prescribed after one panic attack by GP - no psych evaluation

Citalopram Stopped working (no taperiing, just a hard switch to Venlafaxine)

2013-2018 150mg Venlafaxine

Jan 2018 - Came off 150mg Venlafaxine over 2 month period (as advised by GP)

Experienced intense bouts of Depersonalisation and Derealisation due to rapid tapering. Resulted in Psychiatrist evaulation.

March 2018 - Prescribed 0.5 MG Risperidone (for sleep) and 20mg Prosac

May 2018 Came of all drugs after drug induced Akathisia

 

( mod note: moved to the most relevant topic for this post)

 

Hi Chineoh,

I have not had what you describe while on medications, nor since coming off. 

But I still think it might be due to some autonomic nervous system dysregulation.  I'll leave that for you to google.

It IS confusing and frustrating sometimes.  I'm sure hoping you've experienced some improvements, over time.  I know I sure have in many areas.  Stress in general, is still hard for me........the physical stuff I do just fine with thankfully, now.  I was off balance for awhile and wobbly........that has all improved for me.

 

Best.  I hope that helps and perhaps others will chime in.

 

Edited by manymoretodays

Started with psycho meds circa 1988 I think 27 or 28 total.

AD's, antpsychotics, antiseizure mood stabilizers. Lithium, lamictal ,benzos, and stimulants. Some med. for narcolepsy once(Provigil,) Gabapentin........probably more.  Ask me?......I probably was on it.  Haphazard W/D's by Dr. recommend or uneducated self.

10/2014- off Lexapro--had been on highest dose 10 mg. then 5 mg. for a couple of years, went from 5 mg. to 3 mg. liquid and then CT in hospital(voluntary).  I got out of the hospital on a combination of low dose adderal salts x1/day and trileptal 150mg. x2/day.

5/28/2015-off Adderal salts 2.5mg. (I had been on that since hospital 10/2014)

12/2015---just holding, holding, holding, with trileptal/oxcarb at 75 mg. 1/2 tab at hs.  My last psycho med ever!

 

3/21/2016---I did some unwise updosing of trileptal/oxcarbazepine with some stressful stuff......doubled the above dose x2 during this last wave but began liquifying again and on approximately 68mg. starting today.  11/12//2016 24 mg. oxcarbazepine  12/9/2016 off oxcarbazepine/trileptal!!!! :) optimistic  2016 December 9- completely off all medications!!!!!

Omega3's,EPA +DHA= 1800 mg/day. Magnesium complex, orally, diluted in a liter of H2O(that I can shake up.....it usually dissolves more completely as the water gets down to room temperature) and/or Epsom salt baths prn.   Vit. C, D3, and E.  B12, melatonin tapered to 1mg., and bioidentical hormones sublingually.  Trace mineral drops.  L-lysine.  L-methylfolate=400 mcg plus daily spinach. Totally ready for a good long window to hit soon and getting better strings of full days and partial days along the way.  Definite improvement overall since I first arrived on the SA survivor ship.  Herb and alcohol free since 5/15/2016.  None of my posts are intended as medical advice.  Please discuss any decisions about your medical care with a knowledgeable medical provider. manymoretodays

 

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pugglesworth

For me, exercise is the best option to relieve withdrawal symptoms. Even just taking a half-hour walk helps quite a bit. I am not at my most fit right now, so I usually do 30 minutes on the treadmill (watching my favorite show, Star Trek) and then some light weight work. The endorphins that get generated are very helpful. I try to eat as best I can and that also helps. I can tell if I eat too much junk food as my mood and energy levels are low.

 

Start small and slow. Life isn't a race. Just get your blood pumping and those endorphins should show up in 20 - 30 minutes. Endorphins are the bodies natural opiates.


Celexa, 40 mg since 2016. Tapered Jun - Aug 2019

Klonopin, 2 mg since 2016. Tapered Jun - Aug 2017. Reinstated 0.5 mg Jan 2020.

Ativan, 1 mg (as needed for panic attacks) since 2016

Lexapro, 20 mg Sep 2019. Quit Nov 2019

Zoloft, 100 mg since Nov 2019. Tapered Apr - Jun 2020

Buspar, 45 mg since 2016. Tapered Jul - Sep 2020

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