lucky12 Brain zaps

[Altostrata]

Does your package look like this? Does it say Anafranil SR on it? http://www.hqmedstore.com/order-anafranil-clomipramine-25mg-tablets-online

 

If YES, you can reduce by 25% by cutting the tablet in half, then cut one half in half again. Do not cut the tablet into 4 pieces -- it's best to cut it as little as possible.

 

Usually we recommend a slower taper, but since you're having serious adverse reactions, a faster taper is warranted.

 

I hope you do not get withdrawal symptoms from this reduction, but you must reduce your drugs somehow.

 

cymbaltawithdrawal looked up your drug-drug interactions here http://survivingantidepressants.org/index.php?/topic/12258-lucky12-brain-zaps/?p=228781

 

Drugs often conflict with each other in the body, creating symptoms such as yours. One place they may conflict is the liver, where many are metabolized. Doctors are supposed to be careful about this, but many ignore it.

 

In short, you are taking too many antidepressants, and they are fighting.

[cymbaltawithdrawal5600]

Alto please clarify this:

 

 

by cutting the tablet in half, then cut one half in half again. Do not cut the tablet into 4 pieces -- it's best to cut it as little as possible.

 

You appear to contradict yourself because the first part of the sentence has an end result of 4 pieces, right?

 

For now lucky, plan on cutting in half and half again (you've got 2 more days to wait, right?) IF your drug is like the picture she showed you. If not you'll get other instructions (and she has to clarify the above discrepancy.)

 

Lucky, do you understand that what you are feeling is the result of the drugs interacting in the body and this interaction is not really something that will show up on tests you might have done at a hospital? And that your body, if treated gently, can recover from this?

 

As the drug gets metabolized out of your system (through your liver and then kidneys and bowel and you excrete it (you know, poop and pee?) your symptoms will start to decrease and hopefully the zaps too. And by cutting gradually and adding less back into the system the body can adjust better than if you just yanked the drugs away.

[mammaP]

Lucky I have to apologise to you, I said that you could make a liquid from anafranil but I was wrong and  I am sorry, I misunderstood.

 

Alto said to break the tablet in half then break one of the halves to take 3/4 .  It can be tricky to cut a half but is easier with a pill splitter. 

 

You will get through this Lucky, the brain zaps are the worst symptom I had but they do settle down eventually, hopefully it will be soon. 

[lucky12]

Yes Alto. It says SR on it and the package in that link is exactly the same as I have. Can I reduce by %50 and maybe the zaps will be gone in 4 days? How worse can it get? Brain zaps are the worst symptom anyways.

[cymbaltawithdrawal5600]

NO, lucky it does not work like that. The symptoms will disappear gradually anyway. Did we not emphasize enough that this needs to go slowly and we are only recommending you go slightly faster than we what we usually recommend in order that it may give you some relief but not throw you into full blown withdrawal syndrome? We need to address the drug/drug interaction first and then work on getting your excessive drug cocktail reduced.

 

This will GRADUALLY go away, not in 4 days. The body does not work like that, I repeat.

 

Read back through your thread every day and try to look at the links we suggested.

 

It can get much worse....... we don't want that for you. Your life is disrupted enough as it is.

[Altostrata]

If I were you, I would immediately reduce by 25%:

1. Cut one tablet in half.
2. Pick up one half. Cut that in half.
3. You have 3 pieces. One is half a tablet, the other 2  are 1/4 tablet. Take the half tablet with ONE of the 1/4 tablets.
4. You have taken 3/4 of 150mg Anafranil, or 112.5mg.

 

Please let us know how you are doing.

[lucky12]

I don't understand? One pill is 75mg and it's breakable. If I just reduce one half from the night dose that's already a %25 reducement.

[mammaP]

It will be better if your doses are even, so take 1/4 from each dose to make the 25% to keep things stable. 

[lucky12]

Who does agree with me if I taper of only the Anafranil %50 for now, it'd help me and maybe I can get rid of these brain zaps?

[btdt]

NO! 

Don't do that.  Your getting the best we have right now.  There are really good reasons not to go faster.  I know to ask for a bit of trust is a lot to ask right now given it was trust that got you where you are.  Doing the 3/4 of a pill twice a day is the best bet... how your body/brain reacts to this will be a clue as to where to go next. 

 

I know right now you are thinking this is as bad as it gets that is not correct.  More importantly ... I know it seems like nothing could be more important than stopping the zaps right now... but more importantly will be how this eventual wd which you likely will do will affect your life in the times to come. I do not want to give you more burden then you have already so let sleeping dogs sleep... and just do as Alto suggests for now.  

 

I know missing your life and work is a big deal ... I know.  If you had your appendix out or some other health problem people including yourself would not be expecting you to muscle through it... I am not say to give up on your life... no way... but if you can't do some things right now ...you can't do them.  End of story. Getting back to health as quickly as possible is the idea here and that will take some testing the waters to see your response to the first cut. 

 

I am not sure if your at all functional right now... it is hard to tell from your posts.  I hope your able to care for yourself if you can't please ask for help to get food ect... or order in if you can. 

 

peace

[lucky12]

I have reduced it to %50 for the last 2 days. It's all the same nothing is changing. I can't get out of bed, if I do I'm in big pain. My bed, pillows and clothes are all extremely wet from sweat. Can you give me a full plan? Why does it happen and when will it get better?

[cymbaltawithdrawal5600]

It takes a lot of time to research this and it is disheartening when people go off on their own plan anyway. We see this a lot. You are asking for answers we might have if you had gone slower but you've decided faster is your way. If you now decide to go slower because you start to feel worse you will be see sawing the doses of your drugs and that is a bad plan.

 

I have no suggestions so I'll bow out now and wish you good luck. Perhaps Alto will answer. I don't know.

[lucky12]

I need a schedule/plan for this. While I understand what you are saying I don't have the luxury to take my time. I will trust you without questions and will start applying the plan you give me. I would really appreciate it if I can get the fastest option. I am willing to take risks. I would lose A LOT of things which might put me in a way bigger depression than withdrawals if I can't get this right soon and that means I will go back to square one.

 

Thanks a lot guys. Without this forum I would be totally lost searching for the answers in different places and at different dosctors.

[JanCarol]

Lucky, there is nobody who has the luxury of time - but look at it this way:  if you go too fast, and your whole life comes crashing down around your ears - do you have time for that?

 

A slow taper often allows you to get on with a normal life, minimize your symptoms, and choose when you are "out of sorts," - but a too fast taper is like falling off a cliff - you don't know how far down it is, how your will land, and how many pieces you will be in at the bottom.  It's better to abseil gently down that cliff with a slow taper.

 

Please consider the suggestions which have been made here for slower dosing.

 

Of course, we also continue to help people who ignore our advice when it goes wrong - but are you sure you want to test those waters?  You are already experiencing symptoms.  Any symptoms are an indicator that you are tapering too fast.

 

I hope you see the sun today.

[Altostrata]

Lucky, how exactly did you reduce by 50%?

 

How are the brain zaps?

 

It will take at least 4 days for a change to fully register in your body.

 

In your first post, you said you were sweating. When did this start?

[lucky12]

Sweating started as soon as I started taking meds but was not too bad. Last 1 week it's like a joke. Brain zaps were not noticable before this month but right now it's not bearable. It literally gives me pain.

 

I reduces the %50 by taking half of the 75mg pill in the morning and other half in the evening. I have been doing this for 2 days.

 

Yesterday you guys got me seriosly scared so this morning I took a whole 75mg and I'm planning to take half of the 75mg tonight. So this will be reducing %25. I would like to reduce %50 but you guys didn't seem to agree.

 

No change in the zaps. Sweating got much much worse.

[lucky12]

JanCarol, I was not withdrawing when these symptoms started so what you say "Any symptoms are an indicator that you are tapering too fast." is not necessarily true at this point, actually it's totally wrong considering the last month that I have been suffering since I wasn't withdrawing from ANYTHING. I am not in a period of my life which I would choose to withdraw from SSRIs. This came and found me in the middle of the business season like a ******* joke. So yes, I am asking you guys the fastest solution to get rid of it, even if it's risky.

 

Thanks.

 

By the way Alto, thanks a lot! really appreciated.

[Shep]

Lucky, I also was having problems before I started coming off these drugs. In fact, lots of people start having mental and physical health issues before connecting their problems to their drugs. Fact is, many of these health issues are misdiagnosed by doctors.

 

Many of us ended up here because we had to come off these drugs at a period of our lives when it wasn't convenient. I was having memory problems before I came off anything. Other people experience severe GI issues, chronic pain conditions, and symptoms that mimic other severe conditions such as multiple sclerosis.

 

So having problems while on these medications is common. But we still recommend a slow and careful taper so you can remain as functional as possible. This is a good thread that explains how these drugs change the very chemistry of the brain - How Psychiatric Drugs Remodel Your Brain

 

Please also read this thread:

 

Why taper? Paper demonstrates importance of gradual change in plasma concentration

 

[Altostrata]

The sweating got worse when you just increased the Anafranil?

 

I'd go back to a 50% reduction, as you were doing it before.

 

Sorry for the confusion.

[btdt]

JanCarol, I was not withdrawing when these symptoms started so what you say "Any symptoms are an indicator that you are tapering too fast." is not necessarily true at this point, actually it's totally wrong considering the last month that I have been suffering since I wasn't withdrawing from ANYTHING. I am not in a period of my life which I would choose to withdraw from SSRIs. This came and found me in the middle of the business season like a ******* joke. So yes, I am asking you guys the fastest solution to get rid of it, even if it's risky.

 

Thanks.

 

By the way Alto, thanks a lot! really appreciated.

 I was also on 10mg Zyprexa and than 5mg and quit it 2 months ago.

I was not withdrawing when these symptoms started so what you say

 

I am not too familiar with zyprexa but I know if I dropped my effexor dose by half I would have been having brain zaps in 2 months...

 

sometimes withdrawal is delayed... it was for me with effexor and I know I could be completely wrong as I don't know zyprexa at all but I am putting this out there as an idea to be considered by those who do know this drug... does zypexa wd cause brain zaps?  is there a delay with zyprexa wd like there is with ADs?  

 

I dont' know lets find out.

[cymbaltawithdrawal5600]

So you have been on 75mg anafanil about 4 days now, right? see your post here:

 

http://survivingantidepressants.org/index.php?/topic/12258-lucky12-brain-zaps/page-2#entry229425

 

I am guessing that you've also probably decided to quit it completely too? Your last post asked for a faster plan (of which we cannot recommend one at this point).

 

I am wondering how you are doing now?

 

It is the sweating symptom we are more worried about (in case you had not realized that) and not the brain zaps. The reason for the zaps has yet to be discovered in your situation. The sweating, however, is more serious a symptom than the zaps. Has it started to decrease at all? The issue may be clouded if you have gone from the full dose of anafranil to half or zero in these last few days. The symptoms don't have a chance to react that quickly.

 

Please stay in touch and let us know how you are. It helps our knowledge and the situations of those here who also read your thread but don't necessarily comment on it.

[JanCarol]

I need a schedule/plan for this. 

 

Lucky, the plan is to see how you react to changes in dosages.  It can get quite extreme.

 

The schedule depends on how you react.

 

JanCarol, I was not withdrawing when these symptoms started so what you say "Any symptoms are an indicator that you are tapering too fast." is not necessarily true at this point, actually it's totally wrong considering the last month that I have been suffering since I wasn't withdrawing from ANYTHING. 

I am sorry - it can also be an effect of the drug (a side effect).  The effects of these drugs are so similar to the withdrawal effects - and you did drop Zyprexa 2 months ago, which may have been masking the symptoms you are having now.  Sometimes the withdrawal effects take 2-6 to sometimes 12 months to fully hit, as Btdt pointed out.  Dropping your zyprexa by half, also can be considered "tapering too fast."

 

That's why we adjust the doses as slowly and carefully as possible - to prevent big crashes 6 months down the line. 

 

But you are in an emergency now, and need to go a little faster than we usually do - which could get quite uncomfortable.  Please see:  Non Drug Techniques for Coping with Emotional Symptoms to see if you can reduce your stress while you are waiting for your last taper to take hold.  It is important to stay as peaceful and calm as possible.  Choose activities which are gentle, soothing, comforting.  

 

It would be best  if you followed Alto's advice and took the same dose morning and evening.  Uneven doses - especially when you are cutting open a Sustained Release tablet.  The more evenly you can take your doses - same time each day, same dose each time - the better result you will get.

 

So - what doses are you taking now, and when?

[lucky12]

I was better for 3 days but mostly sleeping. Now I'm back to square one Incredible brain zaps. How long does it going to take? Is it permanent? Should I reduce to %50 now?

[lucky12]

Please describe me how to take the

 

112.5mg Anafranil

20mg Paxil

200mg Lamictal

50mg Seroquel

 

it got to a point I can't function at all. I tried to go to a meeting, I couldn't even talk and at one point I got so wet in sweat that people started asking what's wrong and I had to leave. I AM ABOUT TO LOSE MY ******* MIND.

[cymbaltawithdrawal5600]

 

Posted 02 June 2016 - 11:16 AM

I have reduced it to %50 for the last 2 days.

 

That would have meant you were on 75 mg. So you upped the dose to 112 mg when?

 

You cannot see saw your doses like that, your body cannot register the change in doses in less than the 4 days it takes for a dose to reach a steady state in your blood stream.

 

You have to be able to follow directions and not go off on your own for us to be able to help you. You were told to try taking a reduction of 25% of your dose for 4 days and report your symptoms. It has been 4 days and I have no idea what dose you have been on for these 4 days since we last heard from you on the 6th. Could you list the days and doses please?

[lucky12]

I have been using the %25 reduced Anafranil for 10 days.

 

Sweating is still at it's worst and did not get better.

 

Same with the brain zaps. I am planning to reduce to %50 in 4 days. Is it alright?

[cymbaltawithdrawal5600]

Ah, but no change in anything is that right? Not better not worse? No NEW symptoms?

 

I am not a doctor nor am I one of the moderators but I would say I think you ought to try another 25% reduction and carefully monitor your symptoms. (that makes it 50% so far, right?)

 

The brain zaps, because we are not really sure what they are coming from (they don't usually come from the drug interactions we ran for you at the beginning of your thread) we cannot use as too reliable of a guide right now. If they get worse, however, with another 25% drop then that means you are reacting to the drop in dose negatively (but that still might be ok if the sweating decreases.)

 

The sweating symptom is more what I think Alto was looking at as the reason for reducing the anafranil first.

 

Here is your drug interaction sheet:

 

Interactions between your selected drugs

 

Major clomipramine paroxetine

 

Applies to: Anafranil (clomipramine), Paxil (paroxetine)

Talk to your doctor before using clomiPRAMINE and PARoxetine.

 

This combination may cause sedation, dry mouth, blurred vision, constipation, or urinary retention. You might also have altered consciousness, confusion, poor muscle coordination, abdominal cramping, shivering, pupil dilation, sweating, high blood pressure, and high heart rate. If you take both medications together, tell your doctor if you have any of these symptoms. You may need a dose adjustment or special test if you take both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

 

Moderate clomipramine lamotrigine

 

Applies to: Anafranil (clomipramine), Lamictal (lamotrigine)

 

Using clomiPRAMINE together with lamoTRIgine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate clomipramine quetiapine

 

Applies to: Anafranil (clomipramine), Seroquel (quetiapine)

 

Using QUEtiapine together with clomiPRAMINE can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate paroxetine lamotrigine

 

Applies to: Paxil (paroxetine), Lamictal (lamotrigine)

 

Using PARoxetine together with lamoTRIgine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate paroxetine quetiapine

 

Applies to: Paxil (paroxetine), Seroquel (quetiapine)

 

Using PARoxetine together with QUEtiapine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

 

See what I outlined in red? Taking those two together might be the cause of the excessive sweating unless you can think of any other reason for it.

 

Your other symptoms, the pain and fatigue might be a part of it too but they are common to reductions of psych drugs anyway. We don't want to assault your system with too big of a drop but we do want to see it respond favorably to a reduction in your drug burden.

 

What do you think?

[JanCarol]

Hang in there Lucky, I've asked other mods what they think.

 

Normally, we would hold longer, and drop less.  But as CW just pointed out, you may be having a drug interaction.  If you quit CT, it could really hurt you, so we're hoping that by having a not-too-fast fast taper you can get out from under the worst interaction.  But we have to be very careful, because too fast could be as bad as too long.

 

At least (or so it seems from here) your taper has not made things worse?

[JanCarol]

Lucky? 

 

Are you the same?  Or worse?

 

Exactly what dose are you on, exactly what date did you drop?  PLEASE update your signature, so I don't have to keep looking it up?

 

If you are the same, or better, there is one course of action,

 

if this has made things worse, then we need to slow down your taper - but I can't tell you anything until you tell us what is happening.

 

I hope you see the sun today!

[lucky12]

I'm still the same and this is driving me crazy. This took my life away from me. I can't work or function in any other ways. I can't even socialise. I'm in serious physical pain all the time. Brain zaps feel like I am literally getting electric shot in the head and they are strong. I will have to start a benzo or something similar if this doesn't go away soon. I can't take this anymore. I don't even have a break anymore. I start to feel it from the time I wake up till I sleep. It just gets worse as I'm awake.

 

And from what I read we don't even know the cause of the brain zaps and someone suggested it's not because of drug interactions?

 

I have been taking -%25 of Anafranil and -%25 of Paxil reduced for 9 days I guess. No change at all. EXTREME BRAIN ZAPS, too much sweating and tired all the time. I try to sleep all day not to feel the brain zaps.

[cymbaltawithdrawal5600]

Lucky, you need to get someone to read the directions we give to you as you have made an error I fear has worsened your symptoms.

 

You were specifically told to reduce Anafranil ONLY by 25%, not Paxil too. YOU CANNOT CHANGE THE DOSES OF 2 DRUGS AT THE SAME TIME.

 

You were told to try reducing the Anafranil by 25% on the 30th of May.  If you reduced that day that would be day one of 125 mg. AND hold the doses of all the other drugs steady and do not take any Concerta. If all went well you would have reduced again 4 days later, June 4 would be the next 25% decrease to 100 mg Anafranil. Wait 4 days, on the 5th day reduce another 25%. So June 8th you'd be on 75 mg. June 12th 50 mg. June 15, 25 mg. Take this for 4 days and be off June 19th.

 

You have not followed these directions. You've been on too high a dose of Anafranil without reducing and somewhere in there you got the idea to cut the Paxil, we did not tell you to do that.

 

I have no advice for you except to follow directions.

[lucky12]

Ok I will follow the exact directions. Hope this gets better. Thank you everybody.

[JanCarol]

Lucky, I can't help you until your signature is accurate.

 

What date did you decrease Clomipramine?  What date did you decrease Paxil?

 

How do you intend to follow instructions now, that you are suffering from symptom withdrawal, and now you have decreased two drugs, and we no longer have a clean slate?

 

How am I supposed to help you, when now, I don't know what is happening?  I'm so sorry you are struggling.  

 

Please, get me complete information.  I'm concerned about you dropping Paxil at the same time as the Anafranil?  Is that what happened?  Why did you do that?

 

I've asked mods for what to do next - you are already suffering from possible adverse reactions, and complex double moves like this make it very difficult to see what is causing your problems or where to go next.  Please hold at wherever you are, please update your signature with dates and doses so that moderators can better understand the problem here.  

 

We don't need symptoms in the signature so much as dates and doses, as well as dosage changes.

 

I'm sorry you are struggling, it sounds like the Paxil drop made you worse.  I am sorry to hear this.  But if we're going to figure it out going forward, we need to know that you are 

1.  Only making one drug change at a time, and

2.  Have accurate doses, dates, and dates of changes in your signature.

 

Sorry to be so demanding when you are feeling bad.

[JanCarol]

Lucky, just picked up on this one:  

 

 

Ritalin/Concerta: Just when needed at hard working days and coffee was not enough. I've also got diagnosed ADHD but I don't even believe it's an illness.

 

I don't know when you do this, but have you ever considered switching to bulletproof coffee?  

 

The recipe calls for 2 Tablespoons MCT oil and 2 Tablespoons grass-fed butter, but I take my coffee with 1 teaspoon coconut oil (it's cheaper and more complete than MCT oil), and 1 teaspoon grass fed butter. 

 

It provides a gentler, more sustained support than the spikiness of coffee.  Perhaps you can use bulletproof instead of resorting to ritalin or concerta?  Do you have scripts for BOTH of these?  What kinds of dosages?

 

Again, I can't really help you until I get accurate information about your tapers and doses.  It's one thing to come in here and complain of symptoms - it's more significant to help us find out what is causing them.  Otherwise, it's extremely difficult to help.

[lucky12]

I went to my doctor and after a few weeks I was able to quit Paxil and lowered the dose of Anafranil to half a pill in the morning and 1 pill in the night. It was all gone and better for a week and now it came back! What may be the reason of this? I simply don't understand.

[scallywag]

lucky, your brain zaps disappeared probably because your central nervous system was in shock by the sudden drastic change in Paxil. Once it recovered from the shock, it started doing the work it needs to do to adjust to the new Paxil-free state; we experience this intense adjustment as symptoms like brain zaps among others.
 
People often have a brief perid of 1-2 weeks with no symptoms after stopping drugs like Paxil and Anafranil. Then -- like you -- they get withdrawal symptoms.
 
Please re-read your introduction topic from the first post or from here - the first detailed reply from (cymbaltawithdrawal5600).
 
You have asked moderators for suggestions on what to do.  They have suggested that you reduce only the Anafranil SR dose. They suggested that you split your total Anafranil SR dose equally between morning and evening doses.
 

... I'm concerned about you dropping Paxil at the same time as the Anafranil?  Is that what happened?  Why did you do that?
 
... I'm sorry you are struggling, it sounds like the Paxil drop made you worse.  I am sorry to hear this.  But if we're going to figure it out going forward, we need to know that you are 
1.  Only making one drug change at a time, and
2.  Have accurate doses, dates, and dates of changes in your signature.

 
 
You have
- tapered your Paxil dose to 0 within a few weeks,
- cut your Anafranil SR dose unevenly at the same time as you were making drastic cuts to your Paxil dose.
 

I went to my doctor and after a few weeks I was able to quit Paxil and lowered the dose of Anafranil to half a pill in the morning and 1 pill in the night. It was all gone and better for a week and now it came back! What may be the reason of this? I simply don't understand.

 
Please let us know:

 

1. Why did you reduce your Paxil dose to 0 mg?
    
2. When (the actual date) did you take your last Paxil dose?
    
3. Please confirm your current Anafranil SR dosing:

• 37.5 mg half pill in the morning
• 75 mg in the evening