Alphie's Daughter: tapering advice for her

[Alphie]

If my daughter at any time during her taper begins to have uncomfortable symptoms, what do you recommend we do? Do you recommend going back to the last dosage amount and staying/holding at this dose for some time until she feels comfortable and then start a slower taper at a lower dosage of perhaps 5% taper?  

 

From what I'm finding/reading from most folks tapering, when getting down to a lower dosage, most start experiencing uncomfortable and sometimes life threatening symptoms.  What do you recommend we do at this time?

 

Thank you in advance.

 

Alphie 

[mammaP]

There could be some discomfort after a drop in dose, but this should settle down. Don't make any more cuts when suffering withdrawal from a previous cut, wait until  she has been stable for 3-4 weeks before another cut then make future cuts smaller. If a cut causes withdrawal that is more than a little uncomfortable for longer than a few days it means the cut was too large. You will both get to know how she is responding to the taper and be able to adjust accordingly. 

 

I am glad that she has you to help her with this, and is willing to let you in. It is heartbreaking to watch our children go through it. 

 

Hugs from one mamma to another. 

[ChessieCat]

Alphie's question:  "Do you recommend going back to the last dosage amount"

 

mammaP's response:  "If a cut causes withdrawal that is more than a little uncomfortable for longer than a few days it means the cut was too large."

 

If a cut causes me unbearable withdrawal symptoms I have found it better to increase my dose by a very small amount, not go back to the last dose I was taking.

[Alphie]

My daughter is nearing her second dosage cut/taper.  I have to be honest, I'm feeling anxious.  I would appreciate any recommendations.  

 

What can she expect to feel when making a cut?  What do you recommend if she feels withdrawal?  etc...?

 

Thank you kindly for your assistance.

[mammaP]

If she has been ok since the last cut she should be fine with the next one.  If she feels any mild withdrawal it should pass in a few days. It it is vry uncomfortable then do as Chessie suggested and go up slightly but not back to 180. Future cuts should then be smaller, 5% instead of 10. 

 

You are doing great amd I am so glad she has you to support her and while suffering your own withdrawal can't be easy. 

[Alphie]

Okay, another support group recommends tapering, when on more than one psychotrope, together at a rate of 2% to 5% every 2-4 weeks.  Their reasoning is that it is less traumatic for folks.  Further, when tapering one at a time, the brain has to adjust to each drug at the end of each taper making it more difficult with several tapers.  Another recommendation I've seen from this group is they do not promote dosing back up if experiencing side effects as it is said to create Kindling.  

 

Thoughts are appreciated.

 

My daughter was originally on 200 mg Zoloft, 50 mg Trazadone, and 25 mg Topiramate.  I started her Zoloft taper 10% every 4 weeks, and she is currently down to 132 mg.  I've noticed after this last drop she's having more anxiety, so I'm watching her closely.

 

Any thoughts on tapering Zoloft at 5% and Topiramate 2% every 4 weeks?  

 

Thank you in advance.   

 

 

[mammaP]

We do not recommend tapering 2 drugs together because if there are any withdrawals you don't know which one is responsible. We have many members and have found this to be the best way.  If you feel that the other group is best for you then you can do as they advise but we can't put things right if they go wrong. There are many groups out there for tapering different drugs and most have their own protocol. I started with 3 groups and was often confused by which one to follow. I followed one for a year and tapered effexor, then had terrible withdrawals because it was too fast and had to reinstate. It was a hard time for months while I was stabilising. I then found SA and eventually dropped the one which had advised my taper. Then dropped the other one because there was no one overseeing it and it was just people's experiences and what worked for them.  Alto has done lots of research and interviewed many doctors, pharmacists and psychiatrists as well as listened to and logged the experiences of all the thousands of members here.  You must choose the path that is right for your daughter and if you choose to do the taper recommended by the other group I sincerely hope it goes well for her. 

 

As she is now suffering some withdrawal symptoms it will be best to hold for a while until she has been stable for 4 weeks before the next cut of zoloft. If she doesn't show any sign of improving in a few days it moght be best to updose slightly, maybe to 135. We try to get people off the drugs as safely as possible and in such a way that the brain adjusts between each drop in dose and when the final dose is taken there should be few symptoms if any. Then the nest drug can be tapered. Some people taper a drug part way, then taper another part way and so on, altenating tapers and that can work well. 

 

 

[Alphie]

Thank you for your insight, mammaP.  

 

Yeah, after checking out this other support group a couple months ago, I'd recently seen their protocol on tapering.  I had no intention of altering our current tapering method. I wanted to run it by this group to get your thoughts.     

 

You mentioned some folks tapering one drug part way, and then taper another part way.  What are your thoughts on holding the Sertraline at 100 mg and then start tapering Topiramate?  Also, are you aware if Topiramate comes in a liquid?  Otherwise, do you recommend staying at our current course of action?

 

Thanks for your help!

[scallywag]

Alphie, there was a nother member who posted that he was doing what I call an interleaving taper:

Month 1 decrease drug A by 10%

Month 2 decrease drug B by 10%

Month 3 decrease drug A by 10%

Month 4 decrease drug B by 10%, etc.

 

Regrettably, he hasn't posted in at least 6 months so I don't know how this has worked for him.

 

We would suggest doing that ONLY after your daughter has a few months tapering each medication so that she understands how her CNS (central nervous system) reacts to the dose decrease.

[Alphie]

Thank you, Scallywag.

 

Yeah, it would be interesting to see how the other member has done with this tapering process.  I think I'll have my daughter stick with our current process.

 

Are you aware if Topiramate comes in a liquid?

 

Thank you for your guidance.

[scallywag]

I don't know in what forms Topiramate is available. Check with a pharmacist or google "Topiramate liquid USA"

 

edited to add: Just discovered that there may be a liquid of Topiramate approved for pediatric use.  Still worth checking with your doc or the pharmacist.

Edited August 1, 2017 by scallywag

[Alphie]

My daughter's anxiety has increased since her last taper.  Not sure if it's situational, since she has been under a great deal of pressure and other highly stressful events lately or from her last 10% taper.   

 

We decided to hold for another month rather than tapering another 10%.  My question, shall we try a lower taper (5%) the following taper to be safe or continue at 10% taper?  Any advice is appreciated.

 

Currently at 132 mg Zoloft down from 200 mg. Tapering 10%/ every month.

 

Thank you for your assistance.

 

Alphie's Daughter

 

 

1/9/12: Prozac-discontinued

10/17/14: Lexapro-discontinued

4/14/15 Cymbalta-discontinued

5/29/15: Zoloft-started at started @100 mg/increased to 200 mg; 4/3/2017-180 mg; 5/3/2017-162 mg; 6/1/2017-146 mg; 7/1/2017-132 mg. 

4/30/15: Trazadone-50 mg

6/30/15: Topiramate-25 mg

 

[brassmonkey]

Hi Alphie-- if your daughter is feeling bad anxiety after the drop it could be that 10% every month is a bit too aggressive. It is the baseline taper that re recommend and often needs to be modified for each individual.  Many people who have trouble with a straight 10% taper frequently do much better with the Brassmonkey Slide Method.  It maintains the total drop of 10% but spread out over four weeks with an additional 2 week hold.  This spreads out the shock of the taper over several weeks making the symptoms much more manageable, the extra two week hold allows the the symptoms to stabilize before the next reduction so there is less carryover between drops. No taper is going to be symptom free after each drop.  Adjusting the taper is to reduce the symptoms to a manageable level while still maintaining a schedule that won't last for ever. Many of our members are having great success using this method.

 

Brassmonkey

[Alphie]

Thanks for getting back to me, brassmonkey.

 

Yeah, we have decided to hold, after having high anxiety during the current taper, for another couple weeks to see if it subsides.  

 

Can you tell me what the "Brassmonkey Slide Method" is please?  Is it just holding an additional 2 weeks?

 

Thanks again.

[brassmonkey]

Hi Alphie-- The Brassmonkey Slide Method is a way of spreading a taper out over a series of smaller drops to minimize the symptoms caused by the larger drop, but still maintain the speed of a larger taper.  The original method was to do four 2.5% drops, one a week for four weeks and then hold an additional 2 weeks.  So say you were dropping from 20mgs. The first weeks drop would be to 19.5mg, the second week would be to 19mg the third week to 18.5mg and weeks 4-6 would be at 18mg.  That gives you a total drop of 10% every 6 weeks.  Some people have modified it to do 5% in 6 weeks and some even less.  It's not a good idea to do more that 10%. There are several more detailed explanations on the site, a quick search should get you more information.

 

If you're interested we can help you work through the details.

[Alphie]

Hello.

Update on my daughter:  She is currently tapering Sertraline @ 5% from 200 MG.  Current dose is 60 MG (1-50 Mg Tablet plus 10 MG Liquid).  She has been suffering anxiety, depression, and concentration difficulties over the last year, so I've had her hold sometimes 6-8 weeks at a time before tapering down to the next dose.  

 

She is currently experiencing severe anxiety, depression, difficulty focusing and concentrating, severe lethargy, excessive sleeping, negative and uncontrollable feelings of worthlessness hopelessness, suicidal ideation.  She is using her coping skills the best she can but is suffering a great deal.  I am very worried for her.  

 

I am wondering if it would be beneficial to up-dose the Sertraline until symptoms are relieved.  I've heard this can be beneficial.  However, I've heard this may also be dangerous.  

 

Thank you and look forward to assistance.

 

Current Medications:

 

Sertraline: 60 MG (50 MG Tablet plus 10 MG Liquid)

Topirimate 25 MG

Trazadone 50 MG

 

[ChessieCat]

Before the mods can offer any suggestions they will need additional information about her tapering for the last 2 years.

 

Date   drug    dose

Date   drug   dose

etc.

 

 

[Alphie]

Thank you for your assistance, ChessieCat.  As you've requested, I've added my daughter's tapering history. 

 

My daughter is currently experiencing concerning symptoms for 3-4 weeks such as severe anxiety, depression, difficulty focusing and concentrating, severe lethargy, excessive sleeping, negative and uncontrollable feelings of worthlessness hopelessness, suicidal ideation, and difficulty falling asleep and staying asleep.  I am very worried for her.

 

 

1/9/12: Prozac-discontinued

10/17/14: Lexapro-discontinued

4/14/15 Cymbalta-discontinued

5/29/15: Zoloft-started at started @100 mg/increased to 200 mg

4/30/15: Trazadone-50 mg

6/30/15: Topiramate-25 mg

 

Zoloft Taper:  Combined Tablet and Liquid Sertraline

April 3, 2017   Zoloft   180 mg

May 3, 2017   Zoloft   162 mg

June 1, 2017  Zoloft   146 mg

July 1, 2017   Zoloft   132 mg

August 16, 2017   Zoloft   125 mg  (Difficulty w/10%. Resumed w/5% taper)

September 4, 2017   Zoloft   118 mg

September 17, 2017   Zoloft   112 mg

October 22, 2017   Zoloft   100 mg

November 5, 2017   Zoloft   95 mg

November 19, 2017   Zoloft   90 mg

December 3, 2017   Zoloft   85 mg

December 24, 2017   Zoloft   80 mg

January 21, 2018   Zoloft   75 mg

February 18, 2018   Zoloft   71 mg

April 15, 2018   Zoloft   67 mg

May 20, 2018   Zoloft   63 mg

June 25, 2018   Zoloft   60 mg

 

 

  

 

 

 

[Altostrata]

Hello, Alphie.

 

Since the end of June, has your daughter's symptom pattern changed? Is she still taking trazodone and topiramate?

 

Sometimes when people lower the dosage of one drug in a cocktail, side effects of the other drugs emerge. For example, https://www.drugs.com/sfx/topiramate-side-effects.html

 

To see if this is happening, we will need your daughter's daily symptom pattern to see if any of the drugs are causing symptoms.  Please ask her to keep daily notes on paper about her symptoms, when she takes her drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

Please put ALL your daughter's drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results in this topic, or paste a link to the results.

[Alphie]

Hello, Altostrata. 

 

Thank you for getting back to me.

 

My daughter's symptoms started  2 weeks after her last taper (June 25, 2018).  The severity of the symptoms increased instead of lightening up, so I became quite concerned. 

 

As you can see from her tapering history, she has had to wait longer between the next dose drop.  Her symptoms are stronger with each drop.  

 

She also has PCOS, so with periods, symptoms intensify.    In addition, she is also going through Orthodontic treatment with full braces, so this may attribute to her headaches and perhaps other symptoms, especially when going to a stiffer wire.  She is also attending college and starting her last semester in a couple weeks.   

 

I increased her dose from 60 mg (1 - 50 mg Tab plus 10 mg liquid =".5 ml") to 1 - 50 mg Tab plus .6 ml liquid on August 9, 2018.  She got her period 8/10/18 and is feeling much better today.  I'm going to have her hold this dose for a while and go back to the 60 mg dose.  

 

What are your thoughts on tapering at a lower dose of 2.5%?  Or do you recommend she hold with the Sertraline and start tapering from one of the other meds?

 

Yes, my daughter is still taking Topirimate and Trazadone as are listed in the drug listing.  She takes her meds at the same time every day:  

10:30 am - Sertraline

12:00 am - Trazadone and Topirimate

 

I'll have her notate symptoms as you recommended.

 

DRUG INTERACTIONS: https://www.drugs.com/interactions-check.php?drug_list=2057-0,2216-0,2228-0

 

I appreciate your advice and recommendations are greatly appreciated, Altostrata 

 

Alphie

[Altostrata]

On 8/9/2018 at 2:04 PM, Alphie said:

She is currently experiencing severe anxiety, depression, difficulty focusing and concentrating, severe lethargy, excessive sleeping, negative and uncontrollable feelings of worthlessness hopelessness, suicidal ideation.

 

It's important to see if any of these symptoms become worse at a particular time of day. Her daily symptom notes should reveal this.

 

If your daughter looks at the interactions report, do any of those symptoms describe what she's feeling?

 

Why was topiramate added to her cocktail?

 

I would stay at 60mg Zoloft for the time being, let the symptoms settle as much as they can in the stressful back to school period.

[Carmie]

Hi AD, 

 

How are you doing?💚

[Alphie]

Hello Altostrata.

 

I have conferred with you (Last date: August 12, 2018?) regarding assisting with my daughter's taper.  Her last 5% taper of Zoloft was May 5, 2019, from 50 mg to 47 mg.  

25 mg tablet 

plus 22 mg. liquid (1.1 ml. liquid)

 

She is tapering at 5%.  

 

She has been having symptoms, for 3-4 days,  of nauseousness, diarrhea, loss of appetite, hot & cold flashes, faint, and increased anxiety.  I am very concerned for her.  Is it common to have severe symptoms at a 5% taper?  Her symptoms of anxiety and depression seem to be high with each taper, so we wait until these lighten up to taper her dose.  Note: She has had no fever or body aches.  

*I appreciate your assistance*

 

Alphie

 

 

1/9/12: Prozac-discontinued

10/17/14: Lexapro-discontinued

4/14/15 Cymbalta-discontinued

5/29/15: Zoloft-started at started @100 mg/increased to 200 mg

4/30/15: Trazadone-50 mg

6/30/15: Topiramate-25 mg

 

Zoloft Taper:  Combined Tablet and Liquid Sertraline

April 3, 2017   Zoloft   180 mg

May 3, 2017   Zoloft   162 mg

June 1, 2017  Zoloft   146 mg

July 1, 2017   Zoloft   132 mg

August 16, 2017   Zoloft   125 mg  (Difficulty w/10%. Resumed w/5% taper)

September 4, 2017   Zoloft   118 mg

September 17, 2017   Zoloft   112 mg

October 22, 2017   Zoloft   100 mg

November 5, 2017   Zoloft   95 mg

November 19, 2017   Zoloft   90 mg

December 3, 2017   Zoloft   85 mg

December 24, 2017   Zoloft   80 mg

January 21, 2018   Zoloft   75 mg

February 18, 2018   Zoloft   71 mg

April 15, 2018   Zoloft   67 mg

May 20, 2018   Zoloft   63 mg

June 25, 2018   Zoloft 60 mg

August 9, 2018 - After experiencing severe depression, anxiety, suicidal ideation, difficulty concentrating & focusing, racing negative thoughts, feeling of hopelessness & worthlessness, excessive lethargy and sleepiness, I upped her dose to 50 mg tables plus .6 ml. liquid. Hold until feeling better.

September 16, 2018  Zoloft 60 mg

October 14, 2018  Zoloft 58 mg

December 24, 2018  Zoloft 55 mg

January 20, 2019  Zoloft 52 mg

March 19th, 2019  Zoloft 50 mg

May 5, 2019   Zoloft 47 mg

[Altostrata]

Hi, Alphie.

 

Congratulations on helping your daughter manage her taper to almost a quarter of her original dosage.

 

At this point, I would stop tapering until you can sort this out. How soon after May 5 did these symptoms appear?

 

Does your daughter get worse symptoms at points in her menstrual cycle? Many women report this.

 

How is she feeling now?