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Elexis

Elexis: tapering fluoxetine / Prozac - did I come off too fast?

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Ryder

I wouldn't worry about it. I was forced to stop taking Risperidone start Zoloft Cold turkey. You will be fine. You might be jittery for a month or two but if you just explain to people around you what is happening, you can allow the jitterbug to be there while the body adjusts.

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Elexis

I see, that makes a lot more sense! I was confusing the dose stated on the box (8mg) with the actual weight of the tablet. I've ordered a digital scale and the capsules. :)

 

Spoke to my doctor and she's willing  to allow me to taper over 4-5 months which was waaay better than I expected. I've tried to devise  a tapering schedule, would really appreciate your thoughts on it:

 

So I'm currently on 6mg, three times a day. I'm thinking, drop each dose by 25% hold for 2 days, do the next one and then the next until I have all three daily doses reduced. Then hold that for four days before doing the next reduction. My doses would go:

6mg

4.5mg

3.4mg

2.5mg

1.9mg

1.6mg

1.2mg

 

Then for the next ones I would hold them for two weeks rather than four days. Next doses would be:

0.9mg

0.7mg

0.5mg

0.4mg

0.3mg

The 0.3 would be my jumping off dose.

 

If I've calculated correctly this will leave me with 3 pills left over for if I make mistakes.

What do you think?

 

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Elexis
7 hours ago, Ryder said:

I wouldn't worry about it. I was forced to stop taking Risperidone start Zoloft Cold turkey. You will be fine. You might be jittery for a month or two but if you just explain to people around you what is happening, you can allow the jitterbug to be there while the body adjusts

That's good to know!

Yeah I've warned people I may have a flare up over the next few  months and may be a lot more irritable than usual. I guess if it happens it's just a case of riding it out. :) 

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Ryder

Yuh. I would just say like keep your mind to good use like keep doing the things that don't involve keeping track off the tremors. E.g. Gardening, Drawing.Don't second guess yourself about the doses 6.5, 4.5mg etc, your body will let you know. And if it is really bad, speak up to your doctor about it or someone you trust to get it off your chest.

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brassmonkey

"So I'm currently on 6mg, three times a day."

 

We need some clarification on this; are you taking 6 mg broken into three doses ( 2 X 3 = 6) over the course of a day or are you taking a total of 18mg (6 X 3 = 18) broken into three doses over the course of a day?

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Elexis

I'm currently taking 18mg, split into 3 x 6mg doses

 

I was originally on 24mg a day (split into three doses) but did a 25% reduction about 6 weeks ago.

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Elexis
On ‎24‎/‎06‎/‎2017 at 10:03 AM, Ryder said:

Yuh. I would just say like keep your mind to good use like keep doing the things that don't involve keeping track off the tremors. E.g. Gardening, Drawing.Don't second guess yourself about the doses 6.5, 4.5mg etc, your body will let you know. And if it is really bad, speak up to your doctor about it or someone you trust to get it off your chest.

 

Thanks for the tips, yeah I'm thinking of trying to find some sort of hobby or project to do over the next few months - anything to keep my mind occupied!

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Elexis

Brassmonkey,

sorry to push you but do you or any of the other staff think my taper schedule looks okay? I was kinda guessing with it, I'm not sure if 25% drops are the way to go or to do more frequent 10% ones, it's kinda a rough draft.

I'm gonna have to start my first reductions today or I'll end up off schedule, just be dropping  one of my three daily doses by 25%, then do the next one in a couple of days.

 

Thanks!

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brassmonkey

Decreasing one of your three daily doses by 25% would in affect give you an 8.3% total reduction in your daily dose.  This is well with in our recommended limits and should be fine. The big problem you're going to have is by repeating the process in just two days. It takes a minimum of four (4) days for a dose change to stabilize in the blood and then 4-6 weeks on average for the body to adapt to that change.  We know this from many years of painful experience.  So you would be changing the dose before it even has a chance to get established.  This is very confusing for the body.  You probably will feel better for a while, possibly even feel great.  But all those little misalignments of stability will add up and at some point they will explode and throw your body into destabilized chaos.  This is an extremely painful place to be and takes a very long time and careful management to restabilize and be able to move forward.  In the end it will take a longer time and be a lot more painful than taking the time to do our recommended style taper.

 

I would suggest working with your doctor to keep the prescriptions coming for as long as you need them to do it the recommended way.  Your doctor doesn't have to be on board with the taper method they just need to supply the drugs.  A proper taper from your dosage is going to take several years to complete, but during that time you will be much more comfortable, in control and able to function in life.  Where as if you rapid taper or essentially CT like you describe, recovery will take just as long, if not longer, and will probably be as painful as many of the other members talk about here.

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Elexis

Okay  so the ideal method would 25% reduction of one dose, hold for four days, then 25%, held for four days, then another 25% and all three held for 4-6 weeks.

 

I'm not sure how to approach this with my doctor. I've tried claiming that I need the drug but unfortunately a consultant doctor has insisted the drug gives me no benefit and I am to come off it. I tried to persuade him I  need it and he suggested it's just a placebo.

I've also, in the past, tried explaining to my doctor about withdrawal and the need for a long taper when I was on  Prozac. He dismissed our taper method and withdrawal symptoms as 'not evidence based'.

 

I'm at a bit of a loss at what to do.

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Elexis

sorry think I misunderstood. the method would be a 25% reduction of one dose, held for 4-6 weeks, is that right?

my doctor is only giving me 4-5 months at best.

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Elexis

Brassmonkey,

sorry I'm a little confused here - your first post to me seemed to indicate betahistine would be unlikely to cause withdrawal problems even with a relatively fast taper (I was originally gonna do it over 6 weeks) but your most recent post suggests anything other than a 2 year taper would be dangerous.

I've probably misunderstood something - got the flu at the moment and my brain is foggy to say the least! Would you mind clarifying for me?

 

Thank you

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brassmonkey

Hi Elexis-- You know what, you're not the only one fogged here.  I see that I've been saying contradictory things and It's not making a whole lot of sense to me either.  I going to call in some of the other mods for a second opinion to help get it all sorted out.  I'm really sorry for the confusion. Let me make some calls. 

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Elexis

Thank you, I appreciate it :) 

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scallywag

Elexis, in this post (with the dosage decreases) you say that your plan would leave you with 3 tablets of betahistine. Does that reflect the supply you mention that your doctor has committed to in this post?

5 hours ago, Elexis said:

sorry think I misunderstood. the method would be a 25% reduction of one dose, held for 4-6 weeks, is that right?

my doctor is only giving me 4-5 months at best.

 

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Elexis

Hi Scallywag,

Yes that's right. I calculated I'll have about 90 8mg pills I can use. That was a couple of days ago so it's now down to 85 pills.

 

I may be able to extend it slightly if I tell my doc I'm having a problem mid-taper, I may be able to get an extra 10-15 pills that way but 85 is the most likely amount.

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Elexis

I should add that if it is the case that doing my proposed taper would be very risky/dangerous to my recovery I'm totally willing to go back to my doctor (or try a different doctor) and try  and persuade them, it just doesn't look like I'll have much luck from the way things have gone recently. :( 

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Elexis

The really aggravating thing is I honestly feel the drug helps with my dizziness... but consultant thinks it's all in my head. I think having M.E. often results in you being labelled a hypochondriac. Sigh.

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scallywag

Elexis -- I created a spreadsheet based on your plan

- 25% reductions, one dose at a time;

- Above 1 mg: first 2 dose reductions hold for 2 days, third reduction hold for 4

- Below 1 mg: first 2 dose reductions hold for 2 days, third reduction hold for 14

 

I started with 72 tablets, a total supply of 72 * 8 = 576 mg.  Going down to the last stage you listed where you've held at 0.3 mg for all three doses for 14 days, I calculate that you'd have 28.2 mg betahistine left, just over 3 tablets.

 

So we're either great minds or fools.  What with my world-renowned modesty and prize-winning humility, you can guess which I think applies. :lol:

Edited by scallywag

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Elexis
13 hours ago, scallywag said:

Elexis -- I created a spreadsheet based on your plan

- 25% reductions, one dose at a time;

- Above 1 mg: first 2 dose reductions hold for 2 days, third reduction hold for 4

- Below 1 mg: first 2 dose reductions hold for 2 days, third reduction hold for 14

 

I started with 72 tablets, a total supply of 72 * 8 = 576 mg.  Going down to the last stage you listed where you've held at 0.3 mg for all three doses for 14 days, I calculate that you'd have 28.2 mg betahistine left, just over 3 tablets.

 

So we're either great minds or fools.  What with my world-renowned modesty and prize-winning humility, you can guess which I think applies. :lol:

lol! good to know I  didn't do my sums wrong :D

what do you think of the tapering plan - is spacing them out like I have a good idea? Is 0.3mg a good jumping off dose?

 

I think I will try again with my  doctor when I get the chance... worth a go anyway I figure... but best to have a plan sorted as a back-up.

 

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scallywag

Elexis -- your plan is driven by the assumption that your doctor will not prescribe betahistine again.  The plan you came up with is the best you can do with the supply you currently have. 

 

I have no idea about how your plan will work for you or what is an appropriate dose from which to discontinue.  I know you're looking for some certainty but I doubt there's anyone worth trusting who will give you that.

 

Continue to monitor your symptoms. Get thee to thy doctor if they get worse.

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Elexis

Fair enough, yeah 'best I can do' is probably all I can  hope for if this is my only supply... Planning to try speaking to my doctor again soon or getting a second opinion.

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Altostrata

Elexis, I merged your topic discussing Betahistine in the Tapering forum with this one.

 

On 6/28/2017 at 10:58 AM, Elexis said:

The really aggravating thing is I honestly feel the drug helps with my dizziness... but consultant thinks it's all in my head. I think having M.E. often results in you being labelled a hypochondriac. Sigh.

 

I don't understand why the consultant wants you off Betahistine, if it seems to help. Drugs like this one are very commonly prescribed for vertigo. Is it very expensive?

 

If the issue is the consultant simply doesn't believe you have dizziness, etc., if I were you, I would appeal for a new consultant.

 

If you stick with your current plan to go off Betahistine -- which seems a needless complication given your difficulties with Prozac -- you might reduce a bit, see what happens with your symptoms, and if they get worse, raise a ruckus to get your Betahistine prescription reinstated.

 

You do not seem ready to come off this drug now.

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Elexis
9 hours ago, Altostrata said:

I don't understand why the consultant wants you off Betahistine, if it seems to help. Drugs like this one are very commonly prescribed for vertigo. Is it very expensive?

 

If the issue is the consultant simply doesn't believe you have dizziness, etc., if I were you, I would appeal for a new consultant.

 

If you stick with your current plan to go off Betahistine -- which seems a needless complication given your difficulties with Prozac -- you might reduce a bit, see what happens with your symptoms, and if they get worse, raise a ruckus to get your Betahistine prescription reinstated.

 

You do not seem ready to come off this drug now.

Hi,

The consultant believes I have dizziness but he believes it  is 100% caused by a condition called Vestibular Neuritis for which betahistine is not indicated as a treatment. He thinks the benefits I claim to have from the drug are a placebo or as he put it  'a comfort blanket' for me.

 

However, I suspect at least some of my vertigo is M.E. related. Skeeter is looking into  that side of things for me, once I have some info I can print off and take in to see the G.P I'm gonna request to stay on the drug. As you say, it's a needless complication to have to come off it (especially at speed). I'm hoping they'll at least let me stay on until I can be seen by an M.E. specialist.

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Skeeter

Elixis,

Thank you for the info on your current health condition. With ME/CFS, as you advised me it is common to have vertigo.   Now, it was my intention to first read your thread, and then begin to post here, but then you told me about the time frame you were on due to your doc only giving you a limited number of pills has now changed, and you are staying on your current dose due on an increase in vertigo after trying to decrease, so we now have that concern for you but you have what I think is a good solution on hopefully keeping the doc prescribing the drug, your quote is below from just a few minutes ago, you replied to me why finding another consultant was pretty near impossible, due to geography, and that the NHS docs will not contradict each other, but hopefully the neuro will look at things in a different way:

Quote

Next schedule appointment is 21st July. This is with the same GP I have been seeing, who agreed to my taper schedule. I'm gonna tell him how I've tried to taper and my dizziness got worse. Thinking of bringing my dad into the consultation (he lives with me) - who can attest to how my functioning deteriorated during taper (the dizziness particularly affects my ability to travel).

At my current pace I'll run out of tablets in 6 weeks.

 

Honestly I doubt I'll have much luck finding an  M.E. specialist. There are only three clinics in my whole country - two of them are 5 hours away and one is even further. I'll double check but I know that the nearest one to me doesn't actually have M.E. doctors... just physiotherapists. And they won't do telephone appointments. I'll double check the other two clinics though cos I don't know so much about them.

The G.P I'll be seeing on the 21st has previously tried to find me an M.E. specialist and failed however he offered me a neurology referral instead. I'm thinking, if he doesn't agree to me staying on the betahistine, of asking him to allow me to stay on it until I can see the neurologist.

If he won't listen to me at all then I'll try another G.P. at the same practice (though NHS doctors tend to close ranks so hopes are not high!).

 

Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome is a misnomer (the CFS part, anyway).  Not everyone has fatigue, and it is far from the only sign or symptom that people have.  You are right, many docs brush off your complaints or think it is all in your head.   At the bottom of this paragraph is a link to a forum I found that explains how common vertigo is with ME/CFS, and also explains a lot of other symptoms I was not aware of. I know you report that you have some level of dizziness most of the time despite taking the betahistine, but it takes the edge off, and you, before this virus hit early this year, you had been prone to lightheadedness anyway, esp after being ill or after stressfull events had issues with this, so this is not new, but the severity is.   I was asking today about your history of vertigo (response quoted below). Also, here is a forum that talks about ME/CFS and vertigo (plus other symptoms) in depth: http://forums.phoenixrising.me/index.php?threads/vertigo.78/                                                                                                                 I will try to find some medical papers , studies, or legit sites that verify this, and provide links, so you can take it to you doc to hopefully talk him into prescribing more betahistine, so you can come off as you choose.  That said, I could find little to no mention of issues with coming off of betahistine, though everyone is different, and you mentioned that you ae very sensitive to medications.

 

And your quote from today on your history with vertigo in depth:

Quote

I got the virus around the end of January this year. There was severe brainfog and vertigo. The flu-like symptoms went away after 2 weeks, the brainfog and vertigo improved but did not leave. I wasn't given any medication until going on the betahistine at the end of February.

I've had bouts of vertigo in the past, yes. Since getting M.E. I've had short bursts of it where the room will suddenly spin and I have to hold on to something to avoid falling over. It's on my medical records that we thought it was anemia but blood tests showed otherwise. I never did much about it because the dizzy spells were very occasional and only lasted 30 seconds or so andome since I don't drive or work it has never caused a big inconvenience.I got the virus around the end of January this year. There was severe brainfog and vertigo. The flu-like symptoms went away after 2 weeks, the brainfog and vertigo improved but did not leave. I wasn't given any medication until going on the betahistine at the end of February.

 

I have finally read your whole thread!!

 

Regarding Vestibular Neuritis, here is a link with how it is diagnosed and treatments,  Now there are some ways to test if there is any permanent nerve damage in the ear from your virus, and if the ENT did not do the tests (as there can be barely perceptible hearing loss, so if the ENT did not do that, I might request that be done, because without any actual testing, your doc is just guessing at best, but when you were checked for Meniere's, did they do the testing noted in the article?  If not, you have good reason to suggest that the meds continue until proper testing be done.  I would fill your dad in on this information, so he could help you deal with the consultant, I you like.  Please rad the whole article, as there are some unusual s/sx that could crossover into ME/CFS territory. Link: https://vestibular.org/labyrinthitis-and-vestibular-neuritis

                                    

Be well!

Skeeter

Edited by Skeeter
Updated info

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Elexis

Hi guys,

 

I'm just wondering about consistency when  making liquid solutions. My doctors recently gave me my prescription of the drug I'm tapering - it's same drug, same dose but different brand. It seems to dissolve differently  from the one I'm used to. The one I've used for months forms small particles some of which float, the new one forms a very fine powder, none of which floats.

 

I'm concerned about if I will be getting the same dose when I stir it and draw up 10ml of solution? Has anyone else had this issue?

 

Thanks a lot :) 

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baroquep

Hi Elexis, I've merged your question regarding brands back into your introduction thread as it will be seen by more members who will have an opportunity to assist and help answer your question based on their own experiences with generic brands.  I am also including a link to Surviving Antidepressants discussion regarding brand names/generics which might help.

Generic Versions vs Brand Versions of Antidepressants

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Elexis
Quote

Hi Elexis, I've merged your question regarding brands back into your introduction thread as it will be seen by more members who will have an opportunity to assist and help answer your question based on their own experiences with generic brands.  I am also including a link to Surviving Antidepressants discussion regarding brand names/generics which might help

Hi, thanks for the reply

I had a look at my pills and it seems they're all generics, just owned by different manufacturers. I don't think I've ever had the brand name drug.

Thanks for the link, I had a quick skimread - forgive me, I have the flu atm and reading gives me  headaches so I can only do a little bit for now. Sounds like switching from brand to generic can cause a lot of problems. Is generic to another generic generally less problematic? (though if they're dissolving differently that could suggest a problem?)

 

Hope this isn't a problem as I can't think of any way to explain to my GP I need one type of generic over another (they don't 'believe in' withdrawal). Argh.

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Elexis

Just had a rifle through my meds supplies and it appears that I have been switched from brand name Lyrica to generic a couple of months ago and have had no issues. I've also been switched between generic brands on amitriptyline several times (can't say how many as it never occurred to me this was an issue) and don't recall any problems. Does this suggest I'm not likely to be someone who is sensitive to a switch from one generic brand of Betahistine to another?

 

It seems I was switched from a generic betahistine to another generic one sometime in the past 6 months, I never even noticed because the pills  looked identical and behaved identically in solution and I didn't have any symptoms. Now I've been switched to yet another generic betahistine but the difference is this one *does* behave differently in solution. It's like the difference between if you crushed a pill into a fine powder and put it in solution versus crushing it into very small pieces and putting it in solution. Will this present a problem do you think?

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Elexis

Does anyone have any thoughts on  this?

 

I'm not sure if  many people see my posts when they're moved to  this thread....?

 

Thanks guys :) 

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Elexis

Starting the new generic brand today, run out of the old stuff. Hoping it will be alright... can't think of a way to explain to doctors why  I would want one generic brand over another... what do you guys think?

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baroquep

Hi Elexis, Sorry to see that you didn't get more responses to your question.  While I don't have any personal experience switching between generics, I do know that many many people have issues switching back and forth.  If at all possible, I would try and stick to one generic "brand" if you are able to.  If you talk to your pharmacy, they may be able to accommodate this request for you.  I am going to post a reply in your topic which will bring it to the top of the queue again and hope that someone who has personal experience with generics is able to chime in.  

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Elexis

Hi guys, Just trying to  figure out if I'm reacting badly to a taper:

 

I know if you drop by 10% say and then withdrawal symptoms appear then to stop and go no further but are the withdrawal symptoms necessarily continuous? I dropped by 10%, had a 2 day flare up about 5 days later. Then was fine for a further 2 weeks, now having another flare up. I can't figure out whether to attribute this to the dose reduction or if it's just a coincidence. I'm due to do another dose reduction soon, unsure whether to do it.

 

Thanks!

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Carmie
On 3/8/2018 at 1:25 AM, Elexis said:

Hi guys, Just trying to  figure out if I'm reacting badly to a taper:

 

I know if you drop by 10% say and then withdrawal symptoms appear then to stop and go no further but are the withdrawal symptoms necessarily continuous? I dropped by 10%, had a 2 day flare up about 5 days later. Then was fine for a further 2 weeks, now having another flare up. I can't figure out whether to attribute this to the dose reduction or if it's just a coincidence. I'm due to do another dose reduction soon, unsure whether to do it.

 

Thanks!

 

Hi Elixis, 

 

Withdrawals aren’t linear. They are all over the place and can happen at any time. They can come and go. New ones can come up and old ones can go away and come back again. 

 

Before you taper make sure youve been stable for quite a while. Give it at least four to six weeks before taoering again. 

 

Wishing you all the best💚

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Elexis

Do you need to taper ibuprofen?

 

Hi guys, 
I withdrew from an SSRI about 3 years ago and have had pgad symptoms ever since which have slowly improved with time. I've also been taking 400mg of ibuprofen every night for chronic pain for the past 2 years. 
Recently I started getting ringing in my ears and was worried that ibuprofen might be the culprit and so two nights ago I dropped my ibuprofen dose to 200mg a night. My pgad symptoms have increased today and yesterday do you think this could have anything to do with the ibuprofen reduction or is it just a coincidence? 
 Thanks 

 

Edited by ChessieCat
added topic title to post

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ChessieCat

I love google 🧡

 

From https://www.webmd.com/a-to-z-guides/do-i-have-tinnitus#1

 

"More than 200 drugs can cause tinnitus, especially when you start or stop taking them. These include pain relievers like ibuprofen or naproxen, as well as certain antibiotics, diuretics, aspirin, and chemotherapy medicines."

 

3 hours ago, Elexis said:

My pgad symptoms have increased today and yesterday do you think this could have anything to do with the ibuprofen reduction or is it just a coincidence? 

 

Did your pain increase?  That may have caused additional stress which in turn ramped up your symptoms.  Or you may not have slept as deeply without it.  If you stopped them deliberately just knowing that you weren't taking them can add stress.  These are just my thoughts.

 

4 hours ago, Elexis said:

Do you need to taper ibuprofen?

 

Because you've been taking it for 2 years, and your PGAD has increased, it might be worth going back on it and tapering it.  I doubt it would be anything like getting off a psychiatric drug, simply because psychiatric drugs change the chemicals in our brains.

 

Maybe just listen to your body as you reduce the dose.  If symptoms increase, updose a bit and then reduce less.

 

I've searched using google and can't find any information.

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