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MatGMax

When to end the taper and jump to zero?

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aberdeen

By the end of my taper, below 1mg, at some point I started reducing by 0.1mg every 5 weeks. I did that until I was taking 0.1mg and then stopped. I didnt find my symptoms to be any different than all along to be honest. 

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erer
1 hour ago, aberdeen said:

By the end of my taper, below 1mg, at some point I started reducing by 0.1mg every 5 weeks. I did that until I was taking 0.1mg and then stopped. I didnt find my symptoms to be any different than all along to be honest. 

 

Thank you aberdeen, your input is very important to me. I am still going to be very careful and watch my symptoms, but I feel it is also important to be able to believe that there can be a positive scenario. (Have been reading lately about placebo, nocebo and the power of one's mind). So thank you for giving me an option to believe that there is a way.

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miT
On 5-8-2017 at 0:07 AM, erer said:

This is why I have created a tweaked schedule for myself where I've rounded up the amounts. That again means that after reaching 1 mg the reductions will be 0,9 mg to 0,8 to 0,7 etc. Jump from 0,2 mg to 0,1 will be a 50% reduction. 

 

I'm not there yet (currently at 3,7mg), but I'm planning to follow the same schedule below 1mg. I'm not gonna ask my doctor to prescribe 0,675mg of paxil...

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erer
On 12/08/2017 at 0:14 PM, miT said:

 

I'm not there yet (currently at 3,7mg), but I'm planning to follow the same schedule below 1mg. I'm not gonna ask my doctor to prescribe 0,675mg of paxil...

miT, how are your symptoms so far?

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miT
1 hour ago, erer said:

miT, how are your symptoms so far?

 

I feel it’s getting harder and harder on the low doses. I’m intending an extended stay (2 months) on 3.5mg.

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rapunzel2

what's the jumping off dose for seroquel? I'm planning it to be 2,25mg. I wonder in what dose others have jumped off?

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ChessieCat

Hi rapunzel, I think jumping at 2.25mg may be too high.

 

Think of it this way, you have been going carefully up until now, why not continue to be patient and do it the better way rather than risk upsetting things.

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brassmonkey

The thinking several years ago was that 1mg was a good target for jumping off.  Sadly that has been proven wrong on many occasions.  It is best to taper as low as possible before jumping.  If at all possible 0.1mg or smaller.  Those tiny doses are a pain to try and work with, but it will really pay off in the end.

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Altostrata
On 10/16/2017 at 8:06 AM, Drugrage said:

Once on ssri never off ssri. 10% of 0.01 is 0.001

 

Guys come on at some point just drop down to 0. 

 

Please dont be obsessive 

 

The funny thing about this is that you don even get an even dose when it comes to 0.1mg. Just the bare fact that the actual dose you get from the meds vary proves my point.

 

But then homeopathics exist ..

 

Even if 0.1mg only has a placebo effect, we respect that some people who have had a difficult time might fear to come off the drug and prefer to be extra-extra cautious.

 

In fact, we have reliable reports from people that they can feel the effect of 0.1mg. Having been hypersensitive myself, I have no doubt this is so. Paroxetine, for example, can be so difficult to come off, people will reduce by fractions from even 0.1mg.

 

Drugrage, before posting snide remarks on this site, you would do well to look around and see how other people are doing.

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AmyK

I went down to way under 0.1 mg zoloft. I felt every step...

But I was able to microtaper the last tiny bit quite quick. 

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Lakelander82
On 8 November 2017 at 7:02 PM, AmyK said:

I went down to way under 0.1 mg zoloft. I felt every step...

But I was able to microtaper the last tiny bit quite quick. 

 

Not meaning to be argumentative in anyway Amy, but when you got down to doses as miniscule as you did, how could you be even sure you were getting consistent doses? It would have been so hit and miss, for example one day you could have been getting 0.08 mgs the next 0.1mgs. 

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AmyK

It was easy. I titrated the last tiny 0.33 mg (1 mg in weight) in water and used a syringe, 

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Lakelander82

I was more referring to your syringe technique. For the life of me, I don’t know how you measured for example, 0.006mg using a syringe. What sort of dilution factor did you use?

 

 It’s purely out of curiousity in case I need to do the same on down the line. 

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AmyK

I put 0.33 mg in 50 ml water. Every 1 ml on the syringe was then 0.0066 mg. (50x0,0066=0.33). 

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KarenRose

This is a super helpful thread.

 

I was beginning to feel strange about having to reduce so very slowly and in such tiny increments and dosages as I have been... Not after reading this.

 

I have tapered for over 2 years, am at 0,05 (!) mg Celexa and have previously tried to jump off at 1 mg, and recently from 0,05. Felt HORRIBLE the first time, and pretty awful this time. I am now stabilizing now at this low, low dose after reinstating, and will then try to taper down lower and lower with long holds, listening to my symtoms and improvements rather than thinking of the numbers. I figure (and hope) that this method will allow me to do a lot of the healing as I go, rather than get hit with a much bigger wave post taper because of wanting to be done.

 

I wonder and sometimes worry if there even will be a point where I feel comfortable jumping off at all, but am trying to chance this fearful fretting to a more sustainable focus on simply continuing to reduce. This way I can live without the nagging fear of having to "jump" and crash - which I have done too many times and am a little phobic about - and should be carrying less and less - and at the end very little - toxic SSRI in my body. I do see signs of healing and this makes me think I am finally on a better path and will eventually be all the way off.

 

I too use liquid and syringes and make sure to mix everything very well. It seems like the dosages are pretty even, but I have no way to know for sure.

 

THANK you to this great, lifesaving forum.

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brassmonkey

Hi Karen-- I understand your fear of taking the jump.  It's almost as bad as the fear of starting a taper. Taking that step into the unknown and previously badly experienced area is a big deal. Cutting down to smaller and smaller doses can be done for a long time. Especially when using liquids extremely small doses are possible.  Taking a long hold to let things stabilize really well and then continuing with small cuts would work quite well.  Then one of these days the jump will just happen.  Taking the tiny dose will become more trouble than it's worth, you'll start missing doses and not realizing it, take a trip and forget to take your meds along.  They are all ways of your body telling you it's time.

 

 

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Frogie
11 minutes ago, brassmonkey said:

Hi Karen-- I understand your fear of taking the jump.  It's almost as bad as the fear of starting a taper. Taking that step into the unknown and previously badly experienced area is a big deal. Cutting down to smaller and smaller doses can be done for a long time. Especially when using liquids extremely small doses are possible.  Taking a long hold to let things stabilize really well and then continuing with small cuts would work quite well.  Then one of these days the jump will just happen.  Taking the tiny dose will become more trouble than it's worth, you'll start missing doses and not realizing it, take a trip and forget to take your meds along.  They are all ways of your body telling you it's time.

 

 

Hi Brassmonkey:

 

Thanks for all the information you provide. It is truly priceless.

 

I'm a long way off from the "jump", but how do you measure a dose like .0065 on a syringe? I'm just curious. I am doing liquid Lexapro as you know..

 

I appreciate you answering my question. I'm really in a bad wave right now. A lot of anxiety with this taper, no nausea as usual. I don't know which is worse lol...

 

Hope you are doing well.

 

Take care,

Frogie xx

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ChessieCat
3 hours ago, Frogie said:

how do you measure a dose like .0065 on a syringe?

 

You need to dilute it so that you can measure and take a larger amount of solution.  You could dilute it so that instead of trying to measure .0065ml you measure .65ml or dilute it more and measure 6.5ml because each ml of the solution will be a weaker dose.

 

If you start working on understanding it now you'll be all ready to go when the time comes ;)

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KarenRose
13 hours ago, brassmonkey said:

Hi Karen-- I understand your fear of taking the jump.  It's almost as bad as the fear of starting a taper. Taking that step into the unknown and previously badly experienced area is a big deal. Cutting down to smaller and smaller doses can be done for a long time. Especially when using liquids extremely small doses are possible.  Taking a long hold to let things stabilize really well and then continuing with small cuts would work quite well.  Then one of these days the jump will just happen.  Taking the tiny dose will become more trouble than it's worth, you'll start missing doses and not realizing it, take a trip and forget to take your meds along.  They are all ways of your body telling you it's time.

 

 

Brassmonkey, thank you very much. What you said here gives me a lot of hope and clarity, something that has been sorely missing in my life since beginning SSRIs.

 

I think this ultra slow end of taper is a great strategy that many people might benefit from - I would have saved years of suffering had I known years ago, so thank you to you and this forum.

 

Best wishes to you and everyone here. Karen

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Nolabud1

 I have been on a very low-dose of Citolapram for 5 months. I started at 5 mg for 2 months, then decided to slowly taper off. I’m now at 2.5 mg. The reason my neurologist put me on this SSRI was due to symptoms of dizziness that were unexplained. She thought I had some anxiety symptoms so she prescribed Citolapram. This past week I went to an eye specialist and discovered I have vision deficiencies that require vision therapy. Anxiety/depression was never my issue. With the low dose I started on, for a limited period of time, and with the very small dose (2.5mg) I’m on now, how long and and at what point do I quit or jump off this SSRI? 

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Gridley

This link gives guidelines about jumping off:

 

 
The thinking several years ago was that 1mg was a good target for jumping off.  Sadly, that has been proven wrong on many occasions, according to Brassmonkey, one of our moderators.  It is best to taper as low as possible before jumping--if at all possible 0.1mg or smaller.  Those tiny doses are difficult to work with, but it will really pay off in the end.

 

Edited by Altostrata
obsolete link

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Altostrata

Merged similar topics.

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Altostrata

Please see the Admin Note I added to post #1 in this topic

 

 

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xyz
On 12/22/2014 at 9:01 PM, MatGMax said:

ADMIN NOTE The 10% rule keeps decreasing the dose but, mathematically, can never get to zero. As you approach zero, when do you simply stop taking the drug?

 

This is a very good question. This site advocates a very gradual taper for greatest safety. You may know of people who quit a drug very easily -- but if you ever had withdrawal symptoms, you are not that person.

 

Everyone's tolerance for dosage changes is different. It could be that you have been tapering by 10% with everything going smoothly. You may also have found you can decrease every 3 weeks or even every week with no problems. Even so, from what we've seen, you will want to taper as far below 1mg as you can. As you go lower in dosage, your system adapts to the lower dosage. Slide off as gradually as possible. 

 

If you are counting beads to taper, at the very end, when you are down to one bead, you will be unable to divide your dose to taper. You might want to skip doses to very gradually go off. This is the only situation in which we suggest skipping doses.

 

Sometimes people find that, even though they've quit at a very small amount, they might get slight, occasional withdrawal symptoms. You can take a tiny bit (such as one bead) occasionally until these withdrawal symptoms stop, which should be within a couple of weeks.

 

Please remember:

 

DO NOT GO COLD TURKEY AT THE END OF YOUR TAPER

 

Cold turkey is cold turkey. Even though you might be down to a tenth of your original dosage, quitting suddenly may still be too much for your nervous system. You can undo all your tapering by jumping off at too high a dosage, and trigger severe withdrawal syndrome.

 

Ultimately, your tolerance for dosage decreases determines the speed of your taper, all the way to going off. Please listen to your body. If at any point in your taper you get withdrawal symptoms, continue going off very gradually at the end.

 


 

Hi All,

 

Apologies if this has been done to death...

 

I was playing around in excel with a taper protocol and thought I'd share.

 

The 10% is a good rule and very good at encouraging people to go slowly.

Something a lot of us have trouble with. (well me anyway...)

 

But like Achilles catching the tortoise, reducing 10% will never get you to 0.

(An aim a lot of us have).

 

I've plugged the following rule into excel (attached) to see how it comes out.

Rule 1:

new dose = old dose - (9% of old dose) - (1% of original dose).

You plug the starting dose in and it will always taper to 0 in 24 months.

Now this may be to quick for some which brings us to ....

 

Rule 2:

If you feel moderate to nasty withdrawal effects then stop and stabilize.

After stabilizing restart taper from current dose.

(which will also reset the end 0mg end point to 2 years from current dose).

 

 

Here is an example of the output for a 20mg taper (though just an example!!)

Month Dose

1 20.0

2 18.0

3 16.2

4 14.5

5 13.0

6 11.6

7 10.4

8 9.3

9 8.2

10 7.3

11 6.4

12 5.7

13 4.9

14 4.3

15 3.7

16 3.2

17 2.7

18 2.2

19 1.8

20 1.5

21 1.1

22 0.8

23 0.6

24 0.3

25 0.0

 

I'll probably look to start this from my current 2.5 mg Lexapro , thus aiming to be at 0 in 2 years.

 

Cheers

 

Damien

ssri_taper.xlsx

 

 

hi damien,

this is an old post, i know.

why does tapering at 20mg or 2.5 mg take the same amount of time to get off?

 

i have another valium taper that i have been holding, waiting to be done with the lex before tapering the valium if this takes an eternity, it is discouraging.

has anyone jumped off of 0.1 mg of lex?

when does the lex taper gets easier? can anyone share?

 

i am slowly switching to the sliding brass monkey method.

cut 2.5% every week, and hold for a week.

 

 

 

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bubbles

I've noticed that too. For me to get down off 9mg, I should be taking nearly 4 years if I plug 9mg into a 10% reducing calculator. A lot of that time is below 1mg.

 

Does the rate take into account the relative strength of the drugs? (My original 100mg of sertraline, for example, might be equivalent to 20mg of escitalopram. 9mg of escitalopram is five times stronger than 9mg of sertraline. Does it matter?

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Altostrata
Quote

My original 100mg of sertraline, for example, might be equivalent to 20mg of escitalopram. 9mg of escitalopram is five times stronger than 9mg of sertraline. Does it matter?

 

It matters because your particular nervous system has adapted to the sertraline and will miss it when it's gone.

 

The 10% curve is logarithmic, it's going to extend to infinity no matter how low the dose is. Practically speaking, you'll have to jump off when you can no longer physically divide the dose. (However, I know of someone who went off Paxil and was dipping a toothpick into liquid at the end -- she was that sensitive to the absence of Paxil.)

 

When you're below 1mg, you'll have to judge from your symptom pattern how meaningful a decrease is to your nervous system. Drugs are dosed at different amounts of milligrams for a normal dose, from 1mg to thousands of milligrams per day. Abilify, for example, is often dosed at 5mg, and 0.5mg decreases (10%) are significant, people often feel them.

 

So the advice to stop somewhere below 1mg is arbitrary. The jumping off point is going to vary from person to person and drug to drug. Point being: It's going to be a very low dose, don't jump off until you're sure you're not going to feel the difference.

 

(Definitely do not jump off part way through your taper, even if it's going well, you're likely to get a nasty surprise.)

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brassmonkey

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

 

I didn't do it that way though.  My taper was based on a 6 week time frame which gives a half life of 9 months.  But it still follows the same progression as above. Also if you change the percentage of taper you will change the half life. If you do a 5% taper every four weeks you double the time it takes. So at 5% your taper half life would be 12 months and at 2.5% it would be 24 months.

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Altostrata

mgai means milligrams of active ingredient -- the amount of the drug in your tablet or capsule.

 

Great explanation, brassmonkey. I added it to the first post in this topic and to

 

Edited by Altostrata
updated

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Frogie

I have a question about this schedule. I'm on liquid escitalopram. If I follow it, I want to take my dosage down to .1, is it safe to jump off at that point?

 

Thanks!

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brassmonkey

It all depends on how you feel at the time Frogie. It is generally considered that the lower the better. Even though it's a very small amount that last cut is still 100% and can be a shock to the system if you're very sensitive. I jumped at .08mgai (milligrams active ingredient) after a five and a half year taper and still felt it, and I was feeling really good at the time.  In my estimation .1mgai is a good place to start thinking about jumping but not necessarily a hard target.

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Frogie
Just now, brassmonkey said:

It all depends on how you feel at the time Frogie. It is generally considered that the lower the better. Even though it's a very small amount that last cut is still 100% and can be a shock to the system if you're very sensitive. I jumped at .08mgai (milligrams active ingredient) after a five and a half year taper and still felt it, and I was feeling really good at the time.  In my estimation .1mgai is a good place to start thinking about jumping but not necessarily a hard target.

Thanks Brass:

 

Like you said, I thought that would be a good place to start thinking about it. I don't want to get into where I'm going down to like .00045 and numbers like that. I can always go down to .08 like you did. I'll just need help getting that number in liquid if and when the time comes. But I'm looking at another 6-7 months before I'm even there.

 

I hope you will be around to help me when the time comes.

 

Have a great weekend. I'm putting one foot in front of the other and trying my best.  Still sad though, but it's only been 2 weeks and I had her in my life 16 years.  Haven't been on the site much, but saw this thread and it interested me.

 

Take care,

Frogie xx

 

 

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bubbles
4 hours ago, Altostrata said:

 

It matters because your particular nervous system has adapted to the sertraline and will miss it when it's gone.

...

So the advice to stop somewhere below 1mg is arbitrary. The jumping off point is going to vary from person to person and drug to drug. Point being: It's going to be a very low dose, don't jump off until you're sure you're not going to feel the difference.

 

(Definitely do not jump off part way through your taper, even if it's going well, you're likely to get a nasty surprise.)

 

Thanks Alto. No jumping off any time soon.

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Tanha
On 12/27/2014 at 3:20 AM, Rhiannon said:

As always, though, your body is the expert on tapering, not a preplanned calendar. We just say 10% of the current dose as a general rule of thumb, a starting off point. How we tolerate reductions is very individual. Making up a plan or calendar ahead of time can give you some ideas, but I can't tell you how many of those I've had to throw out the window when my body made it clear that it does not heal according to a schedule I devise. 

 

Overall, at the lowest doses it's best to go very slowly, in my opinion. The upside of that approach is large: You can minimize the chance of going too fast, getting sick, having to reinstate and start over, and all the disruptions and misery that come with withdrawal. And the downside is very small: at such a low dose, the side effects and dangerous drug effects are minimal, and if you go slow enough to keep feeling good you'll already be enjoying many benefits of coming down to such a low dose so you won't be feeling the need to hurry.

 

So I would say, make those last cuts small and the breaks between them long. Take your time. I have seen many many people get into trouble and fail tapers because of going too fast at the end, but I've never seen anyone fail by going too slow.

 

Let me add, as someone tapering, I know this is easier said than done! You get close to that finish line and you want to rush there. But this is really the time when going slow will give you the maximum benefit for the minimum price.

Dear rhiannon

 

i like your approach. 

Yet i have one problem with slow taper as far as my case is concerned: i am on three drugs 

(and one or more give me not only withdrawl but also paradoxical reactions).

 

slow taper has a downside with this case: 

i cannot stop the paradoxical reaction/sideeffects soon if tapering slowly (my body doesn't even take 10% cuts)

and

i cannot find out the problem causing drug soon

(I have to take both - quetiapine and diazepam four times a day at the same time and mirtazapin also). 

 

Any good ideas are welcome because I have to taper very slow, I feel terrible knowing that after one taper, if I succeed, there Willen two more tapers and only the 250 mg quetiapine take me three years to finish if possible at all. I am bedridden for 9 months now almost all day and so many years tapering ahead.  

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ChessieCat

Posted in a member's Intro topic - citalopram:

 

7 hours ago, KarenRose said:

 

Since I last wrote, I have tapered down my Celexa to 1/800 of a milligram. Yes, that sounds insane and indeed the proces has been. I have tried to jump  off at 1 mg and 1/20 mg and it has been hell. Now I have given up the idea of jumping off or being done and have put all my focus on healing my body and psyche. I have decided to keep tapering until either I don't have any more Celexa drops or I can't feel the drops in dosage anymore. 

 

 

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Tanha
8 hours ago, ChessieCat said:

Posted in a member's Intro topic - citalopram:

 

 

Good that you found a way to deal with the meds. It is scary, though, that you still react to such tiny bits.

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KarenRose

Thank you, Tanha. 

 

Yes, scary it is! Yet I have learned that the ONLY way I can get off of these drugs, or even keep lowering them is to let my body determine the speed and length of taper. Any rushing, obsession with numbers or deadlines have only hurt me.

 

I can tell that I have gotten healthier all the way down from my high dose of 45 mg Lexapro and that drops are easier now. This knowing, my own experience, is what keeps me going. I really hope it will pay off in the end and that going so slow will make the final WD process off the drugs easier.

 

I do wonder if there are success stories to of people who have gone slow and low to "prove" the theory. If anyone here can point to such stories I would love to read them and will keep looking too.

 

The encouragement of these stories are a real placebo for me, in the most positive sense of the word.

 

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