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LightQueen: Which to taper first - buspar or lamictal?

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LightQueen

I'm planning ahead to starting to taper in the next few months but I'm not sure which med is the best to taper first.  Neither drug causes me significant side effects so far as I know and I've been on both of them for over 10 yrs. I am off of Straterra as of this last February (accidental cold turkey stop and had 3 months of hell, but survived it.)

 

Buspar I am very sensitive to - even a generic brand change is enough to give me symptoms as if I've stopped it completely. 

 

I'd appreciate any suggestions about which to do first.

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baroquep

Hi LightQueen,

 

Welcome to Surviving Antidepressants (SA).  I am glad that you found the site before going any further. 

 

Could you please answer a few questions so we have a better idea of what you are dealing with?

 

How long were you taking Straterra?

How did you manage to accidentally cold-turkey off of Straterra?  

What withdrawal symptoms did you experience after discontinuing this drug?  please elaborate.

How long did the withdrawal symptoms last?

Are you dealing with any withdrawal symptoms at the present time?  If so, please explain. 

 

Because you stopped Straterra without a proper taper and have already experienced sensitivities switching from brand name to generic Buspar, this in itself indicates that your central nervous system is already highly sensitized to the actions of these drugs so you will need to proceed very carefully before you start to taper.  Please also be aware that It is recommended that you taper only one drug at a time; this way if you run into trouble, we will have a better idea of how to advise you going further.  

 

Before being able to provide you with specific information regarding to your current situation, we would ask that you summarize your withdrawal/drug history in a signature - ALL drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months in particular?  We ask all members to provide their drug history as a signature.  This will be a permanent part of your introduction and It helps moderators to be able to see all of your details at a glance.  You can find the information on how to complete your signature at the link below:
 
Instructions:  Withdrawal History Signature
 
    •    Please leave out symptoms and diagnoses.
    •    A list is easier to understand than one or multiple paragraphs. 
    •    Any drugs prior to 24 months ago can just be listed with start and stop years.
    •    Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago)
    •    Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016.

 

In the meantime I encourage you to read the links below so that you are familiar with the recommendation made by Surviving Antidepressants.  SA recommends tapering by no more than 10% of your current dose followed by a hold of about 4 weeks to allow the brain to adapt to the changes in the central nervous system (CNS).  When changes are made too quickly, doses are alternated/skipped or the drug is discontinued abruptly, the brain is unable to adapt to the changes and this results in uncomfortable withdrawal symptoms.  
 

Before you begin tapering what you need to know

Why taper by 10% of my dosage?

Taking Multiple Psych Drugs - Which Drug to Taper First

Tips for Tapering off Lamictal/Lamotrigine
Tips for Tapering off Busipirone/Buspar

 

Please feel free to connect with other members of the SA community by posting in their introduction threads, they are a supportive group and happy to offer help and advice.  If you have any questions after reading over the information I've provided, please post all questions regarding your situation here in your introduction thread and one of the moderators will get back to you.  

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LightQueen

 

Hi and thank you for your reply.

 

I've added a signature as best I can. (My memory is limited once I reach a certain point.)

 

In regards to your questions:

6 hours ago, baroquep said:

How long were you taking Straterra?

How did you manage to accidentally cold-turkey off of Straterra?  

What withdrawal symptoms did you experience after discontinuing this drug?  please elaborate.

How long did the withdrawal symptoms last?

Are you dealing with any withdrawal symptoms at the present time?  If so, please explain. 

 

 

I was on Straterra for between 5 and 6 yrs. Unfortunately I don't remember the exact start date, I estimated as best I could in my signature.

 

I came off of Strattera cold turkey due to an error in filling my dosette. My regular time for taking my straterra was in the morning - and I'm not a morning person so typically take my morning meds with my eyes half closed still.  I needed a prescription refill when I filled my dosette, and broke my regular routine of leaving the empty bubble pack next to where I sit as a reminder to add the refill to my dosette and threw it out instead.  So I had straterra in the first 3 days of the dosette, but didn't have enough to fill the last 4 days.  I discovered that I had forgotten to get out a new bubble pack from the refill when I went to fill my dosette for the next week, but by that time I was already off of it for 4 days.

 

I called my psychiatrist as soon as I realized, and he told me the best thing was for me to stay off the straterra and see how things went. He said after 4 days off we would need to taper me up from a lower dose again. I had recently told him I wasn't sure if it was doing anything for me - so he figured it was a good opportunity to see how I did being off of it.  He told me that some people can come off it no problem, other people have a couple of tough weeks, but that it shouldn't be anything too difficult. 

 

My withdrawal symptoms from Straterra:

- Prior to discovering I had stopped Straterra, I had noticed that I was going to the bathroom more - I was questioning if I had a GI bug or something because I was normally pretty constipated and all the sudden I wasn't. I was also feeling queasy and weak - so I figured I was fighting a virus or something. (This would've been approximately day 2 thru 5 after stopping Straterra)

- I felt exhausted and like my brain wouldn't work. I felt unable to form sentences, reading was hard, talking was hard, my thoughts didn't feel like my own. This started around day 5 or 6 and lasted 3 weeks or so.)

- During the first 3 weeks off Straterra I had a worsening of what I call "word replacement" - where I think one word, but either type or say a completely different word. I noticed it when I went on Straterra, but my dr at the time brushed it off. It had stabilized while I was on it - with it only occurring sporadically - but it intensified and became something that happened multiple-times-a-day during the first weeks.

- I had a few weeks where I felt pretty normal and I thought the withdrawal was over, I even told my dr. I felt like the worst had passed. During this "lull" I discovered that I felt more in touch with the world around me than I'd felt in years. I realized that Straterra had had me pretty numbed and I just hadn't realized it.

- About 6 weeks or so after stopping Straterra I got hit by moodiness - being tearful - almost depressed, except I didn't feel truly depressed. I was crying a lot and emotional and really confused and having troubles concentrating. I felt intensely disconnected in some ways - but I was also aware of how disconnected I felt, and it was distressing.  There was another period of my brain feeling "broken" in here - where I just felt like I couldn't think clearly.

- I don't have an exact date for when the last fog broke and I started feeling more like myself again. It happened sometime in late June. So from stopping Straterra to the last symptoms going away would've been about 4.5 months approximately.

 

I am not currently dealing with any withdrawal symptoms.

 

Going back many many years ago, I've tapered myself off of seroquel, celexa, clonazepam, and sleeping pills. All of these I've tapered down based on symptoms - pretty close to what is described on this site actually. Celexa has been gone for 4 years now, the others have been gone over 10 years. As a general rule, my typical pattern during tapering has been to have a few days of feeling really anxious, sometimes intensely sensitive, but usually that would pass in 3 or 4 days and I would be able to do a small decrease again.  The sleeping pills I had to become ok with "resting" instead of sleeping when coming off of them - but there weren't any serious physical effects when I came off the sleeping pills. Celexa I've been on and off quite a few times as they used to give it to me for seasonal depression before it started causing mixed mood states. To be honest, I don't remember a lot of specifics about most of the previous tapers aside from recalling that seroquel I had to break in to crumbs during the end of the taper because I was too emotionally labile if the decreases were too big. (Seroquel was over 15 yrs ago so I don't remember more specifics than that.) 

 

I know that my current med tapers are going to be very different than ones I've done previously, and so I'm planning well ahead of doing them so that I have the best chance of succeeding. I've read the threads about what percent to taper etc, and most of it is in line with what I did back with my purposeful tapers. (Small decrease, wait for symptoms to subside before doing another small decrease.)  I will only consider tapering one med at a time, and I expect them to be very slow and gradual tapers. I plan to talk to my dr. when I'm ready and my husband already knows my goal. 

 

I'm currently making some diet and lifestyle changes that I believe will support my body through the taper process, which is why I'm not ready to start tapering immediately. 

 

I think I covered everything, please let me know if I need to clarify anything.

 

Thanks for taking the time to reply. 

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baroquep

Hi LightQueen, thank you for providing all of the information above as well as filling out your withdrawal history signature.  It is a bit of a relief that you are taking the time to research the safest way to get these drugs out of your system and it is very good to see that you were careful during your previous tapers over the years.  

 

My only concern at this time is the difficulty you had discontinuing Straterra and even though you discontinued it back in February, the withdrawal symptoms, if any still remain, could be well disguised by the Lamictal and the Buspar so if you are not careful, you could end up running into difficulty when you start tapering either of these drugs.  I would agree that you should continue to wait a few months longer before starting a new taper as going cold-turkey off Straterra has likely sensitized your central nervous system and that you have a history of tapering off of antidepressants is another indicator that future tapers may prove to be more difficult.  We aren't sure why these two factors affect the central nervous system in this way, but it is important that you are aware.  

 

One Theory of Antidepressant Withdrawal Syndrome

Withdrawal Symptoms - Delayed Onset

 

Healthy diet and lifestyle changes can be very beneficial in supporting your central nervous system while you are tapering off of psychotropic drugs, but it is important that you are aware of all of the steps you can take to help assist you in being successful in discontinuing Lamictal and Buspar with as few withdrawal symptoms as possible.  If you follow the guidelines recommended here, I am sure that you will be successful in discontinuing these medications.

 

Please keep us posted as to how you are doing and when you are ready to start tapering either Lamictal or Buspar, please let us know and we can help guide you further.  I'm happy to hear that you have been reading some of the other threads so that you know what to expect and are able to make the best choices on how to safely taper off of these medications.  It sounds like you have a good support system already in place and feel that you are going to be successful in your goal.  Please keep in touch and most importantly keep up on your reading and researching!!!  Surviving Antidepressants has a wealth of information on this site and you are in good hands.  

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Altostrata

Welcome, LightQueen.

 

Going on and off psychiatric drugs over the years can make your nervous system sensitive to any changes. From now on, you should probably assume that is true and be very careful with all drugs, psychiatric or otherwise, and even some supplements and foods.

 

If I were you, I'd tiptoe off the Buspar first, see Tips for tapering off busipirone (Buspar)

 

Why are you taking lamotrigine?

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LightQueen

Thank you Altostrata. 

 

I was put on lamictal as a mood stabilizer. I was dealing with a lot of ptsd and anxiety back then and an antidepressant triggered a mania so I was diagnosed bipolar. I'm not really sure how accurate the diagnosis was, vs how much was being a young adult who was dealing with a lot and had never learned any cognitive ways of coping with emotional difficulty prior to being put on meds. 

 

My big reason for wanting to stop buspar is I feel it has the power to make my life miserable if the manufacturer quit making it or even changed their formulation slightly. To me that means it has too much influence/control in my life and I think a controlled taper is better while I have the choice and can do a controlled taper. If it went out of stock tomorrow I would be up the creek without a paddle, and that's not how I want to live my life. 

 

As it stands now whenever there is a shortage I end up calling all the pharmacies in my city until I find one with the right generic brand in stock. It's extremely stressful and i really think a medication shouldn't have so much power in my life. 

 

Thanks again. That was my first thought but when I realized there was a rhyme and reason to which meds were best being tapered first I figured I should check. 

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LightQueen
7 hours ago, baroquep said:

My only concern at this time is the difficulty you had discontinuing Straterra and even though you discontinued it back in February, the withdrawal symptoms, if any still remain, could be well disguised by the Lamictal and the Buspar so if you are not careful, you could end up running into difficulty when you start tapering either of these drugs.  I would agree that you should continue to wait a few months longer before starting a new taper as going cold-turkey off Straterra has likely sensitized your central nervous system and that you have a history of tapering off of antidepressants is another indicator that future tapers may prove to be more difficult.  We aren't sure why these two factors affect the central nervous system in this way, but it is important that you are aware. 

Thank you! The sensitizing is a good point and I appreciate the insight as that's one point I  didn't consider. It seems that there are more unknowns about how a body is affected by stopping these meds than there are things known. I never would've stopped straterra cold turkey had I purposefully gone off it, but what's done is done and I'll just have to see how things work out now. 

 

I expect to begin tapering either the end of November or beginning of January. Ideally I will likely do a small decrease and then leave it a few months if I start at the end of November. Christmas tends to be busy and I know I will only do decreases during times I have a few days of down time available to deal with the initial symptoms. 

 

Thanks again. I'll update when I'm ready to start. 

 

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LightQueen

Just an update that I haven't had any further effects from stopping the Straterra since I last posted.

 

3 weeks ago I discontinued the melatonin and my sleep is back to normal now.  I've also been following a whole foods based diet since October 16, focused on eliminating processed foods, sugar, dairy, and gluten. I've found this diet change has provided a large increase in mental clarity and overall health and while I plan to give it a few more weeks for my body to stabilize further, I am close to being at the point where I'm ready to start tapering the Buspar.

 

One thing that I've found with the change in eating habits is that I have had side effects emerge from Lamictal that have historically meant I need a dosage decrease. Would it be a bad idea to have a dose decrease of 25 mg which should eliminate the side effects that recently increased, let that settle, and then start tapering the buspar? I would hold the Lamictal steady at the decreased dose unless side effects worsened again. 25 mg is less than 10% of my current dose and I have had my dose changed up and down by that amount in the past without problems. Typically decreases have been necessitated by weight loss and the need to decrease has always shown up as an increase in side effects.

 

Thanks in advance to those of you who take the time to share your helpful information.   

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baroquep

Hi LightQueen, glad to hear that you have not had any further trouble with Straterra, knock on wood, it would appear that you are out of the woods and that is very good to hear.  If you would normally decrease your dose of Lamictal due to increased side effects, I can't see that as being a problem, particularly since 25mg is less than 10% of your current dose.  You are definitely on the right track to let any symptoms settle before starting to taper Buspar.  Your idea of waiting to start tapering Buspar in January is a good one and best to be safe rather than sorry.  It would also be a good idea to keep notes on paper to keep track of your symptom pattern which will also help to alert you to any problems you might otherwise miss on a day-to-day basis.   Often withdrawal symptoms, particularly when it comes to our emotions, can be very subtle only to build up and brew over time and personally found that I have to pay particular attention to my emotional health as well as cope with any physical symptoms after a decrease.       

 

I'm reattaching the tips for tapering Lamictal and Buspar and a couple of others for your reference and encourage you to familiarize yourself with the recommendations made by Surviving Antidepressants so that you know what to expect, how to minimize withdrawal and safely taper off of these drugs.

Tips for Tapering off Lamictal/Lamotrigine
Tips for Tapering off Busipirone/Buspar

 

Stabilising After a Reduction - What Does That Mean?

Rate Symptoms Daily to Check Patterns and Progress

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LightQueen

Thank you Baroque! I greatly appreciate the tips and information. 

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LightQueen

Thanks Chessie! I really appreciate the links to the checklist. I will be making sure to use it.

 

I have done my first decrease which is a 25 mg decrease of lamictal to hopefully reduce side effects. The new dose will be held indefinitely until I'm hopefully off of buspar.

 

I plan to start  the buspar taper in January provided that I don't have any problems from the decrease of Lamictal. It was a less than 10% decrease so I don't expect to have any difficulties with it, but I won't know for awhile. 

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LightQueen

I noticed about 48 hrs after my last full 300 mg dose that I started having some non-specific anxiety in my body. My mind itself hasn't been having anxious thoughts, it's more just a physical sensation. I've also had a very mild headache off and on for the last couple of days.

 

I am wondering if this is fairly par for the course, or if it might be better to stair-step the 25 mg by dividing it in to 12.5 mg and then another 12.5 mg decrease in a few weeks or a month? I have 25 mg tablets that I can easily break in half.

 

How long is it best to wait to see if minor symptoms disappear on their own, vs. making a smaller decrease?

 

Thanks. 

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LightQueen

Just posting an update here.  Since my last post, I've decreased my buspar twice (just over 5% decrease each time,) and just decreased my lamictal by less than 5% last week.

 

Overall I find day 5 or 6 to be the most difficult after a reduction, but the lamictal symptoms cleared up quickly this time and the 12.5 mg decrease was way easier to adjust to than the 25 mg increase.  I will most likely be doing another 12.5 mg decrease on the lamictal fairly soon, and then will be holding on both meds until the end part of March I'll do another decrease on my buspar.

 

At this point it seems like alternating decreases, combined with decreases in the neighborhood of 5% are quite tolerable.  My dr. hadn't heard of micro-tapering before, and prefers tapering just one med at a time, so I haven't crossed in to that yet - but I'm still considering switching to micro-tapering both the buspar and lamictal together at some point in the future. I'm largely following instincts at this point since everything I ask my doctor gets answered with him really not knowing. I appreciate his honesty, but it sure would be nice if he had experience with helping people get off their meds.

 

Overall my biggest withdrawal symptoms have been anxiety, headaches, and whole-body restlessness. Not sure if it falls in to the akithasia category or not, but with the buspar in particular there were a few really tough days after the decrease.

 

I'm down to only Vitamin D for supplements now - I had no trouble stopping the tryptophan at all and didn't taper off of it.  

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LightQueen

Just an update here.   I ended up doing microtapers of both the lamictal and buspar together for the last few months. I was cutting my 10 mg tabs of buspar in to 1/8's in order to reduce by 1.25 mg at a time, and got dispersable 5 mg tabs of lamictal so that I could reduce by 5 mg at a time on the lamictal.

 

As of Monday I am down to 20 mg of buspar (so at 50% from my starting dose,) and I'm at 185 mg of lamictal (starting dose was 300 mg on the lamictal.)  I tend to have 1 to 2 weeks of symptoms after each decrease - typically an increase in anxiety, sometimes word recall is affected, I'm more emotional and I think a whole lot more. I'm more sensitive in general.  Sometimes I get akathisia with it but thankfully that's not something that happens every decrease.  I find days 4 thru 6 are the most difficult and symptoms overall seem to be more manageable for me when I decrease the lamictal and buspar together at the same time.  

 

The last few buspar decreases I've done as 2.5 mg decreases and those have been manageable.  I've found a herbal tea made by president's choice (in Canada,) that is chamomile, lavendar, orange oils, and a few other things and it really eases the anxiety when it's bad - the feeling is almost like taking an ativan, so I really recommend this tea for help dealing with anxiety as a result of withdrawal.

I've found the hardest part about withdrawal for me is the loneliness that comes with it.  I often feel like the people around me just can't understand what I'm dealing with, and I worry about talking about it too much.  My doctor has been supportive and is more taking a curious approach as he hasn't had anyone taper these 2 meds before, and hasn't seen anyone taper in such a slow and controlled way before.  He is thankfully willing to write my prescriptions with smaller pills specified so that it enables me to control my decreases carefully.  

 

I plan to hold at this dose for probably another week or so. I may do another small lamictal decrease in a week or so, but have a work trip at the end of August so I won't do any decreases in the 3 weeks prior to the trip.  At this point, I'm hopeful that I have somewhere between a year and 18 months left before I'm off of the meds completely, but I won't know for sure until I get lower on the lamictal. From what I've been finding on the forum here, it's the really low doses that seem to create havoc for some people, so I won't know until I get there what will happen for me. 

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LightQueen

I should add that this last buspar decrease was much closer and without the lamictal than the previous decreases.  I missed my evening meds and decided since I'd already gone a day with 12.5 mg less, I might as well drop the 2.5 mg and see how it went.  This decrease has been a harder one, but it's livable so at the moment I don't think I'll need to go back up. .  

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LightQueen

Posting an update now that I'm a year out since my first lamictal decrease.  I am down to 155 mg of lamictal and 17.5 mg of buspar per day.  At present I am decreasing my lamictal by 0.5 mg/day (total of a 15 mg decrease over the course of 30 days) in hopes that my body will adjust to the rate of decrease so that I can continue tapering without interruptions when work becomes more busy in the spring.  

 

I find that decreases are easier when my lamictal and buspar are at close to the same original balance as they started out, so I am decreasing only my lamictal right now until it gets back in sync with buspar and then I will be getting a liquid for part of my buspar dose that will allow me to make extremely small daily decreases of the buspar in hopes of it not being very noticeable. (0.05 mg/day is my current plan.) 

 

From mid-August through until the end of October I held without any decreases, and found that I had an increase in some symptoms start to ramp up closer to the 2.5 month mark. Once I started decreasing the lamictal in small amounts again, things seemed to improve.

 

I feel like I haven't quite figured out the maximum amount I can push my decreases by, but I'm hoping that the microtaper will allow for some increased flexibility. Either way, I will be at the halfway point by the end of the year and that was my hope, so I'm happy that it has worked out that way.

 

The biggest symptoms I get at present are fatigue, irritability, and tearfulness. i've been getting headaches more often lately too. I knew this would be a marathon, but I think I had really hoped I would be one of the lucky ones who could breeze through 10% decreases without much difficulty.  

 

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LightQueen

Updating here that I've been microtapering both my buspar and lamictal together in very small amounts now for the last month, and so far it's all manageable and many days where I don't have any symptoms at all.  Due to the relative ease I've been having since starting the microtaper, I did a small increase a few weeks ago, so am now decreasing by 0.6 mg/day for the lamictal and by 0.07 mg/day for the buspar.

 

My body definitely seems to be handling keeping the 2 meds in balance better than when I would decrease one, hold, and then decrease the other, and hold.  The microtaper has also greatly improved my cognitive symptoms and "bad memory" days are less frequent and my overall sense of coping through everyday life seems better overall.

 

Today's doses were 113.5 mg for Lamictal (50 mg in morning, remainder at night,) and 15.38 mg for buspar (7.88 mg AM and 7.5 mg PM)

 

I'm getting my buspar compounded at the pharmacy, and am making a suspension for the lamictal myself out of 5 mg chewable/dispersable tablets in an oral suspend solution.   

 

Since this is a bit much to keep track of, I've created a spreadsheet that lists my daily dose and allows me to keep track of what I'm taking each day.

 

It's interesting because when I was decreasing the 2 meds separately using a cut and hold method, I was finding that even a 3% decrease on the lamictal was difficult to handle sometimes.  Now that I'm microtapering both of them, I actually have fewer symptoms.  My doctor isn't 100% happy with me decreasing both of the meds at the same time even in such a slow and controlled fashion because he would prefer to know what med is responsible for what symptom if I get symptoms going out of control, but I feel like I got a pretty good handle on my symptoms with the individual decreases I did prior to switching to what I'm doing now.

 

I don't see the super small daily microtapers discussed much around here, but it's really been a gamechanger for me.  It's allowing me to taper even through life events and work demands that would've required pausing my taper in the past.  I'll continue to monitor and adjust my taper as symptoms dictate, but am hoping to be able to maintain this process. 

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LightQueen

Thanks ChessieCat!  I appreciate the links.

 

A common theme that seemed to come out was to know the withdrawal symptom pattern for a medication before tapering it, and if doing a joint microtaper, know the symptom pattern for each med individually.  I want to be  clear for anyone reading my thread that I have done both of those things, and that I have had a number of holds over the last year and have been pretty cautious. My current rate is manageable, but I will definitely hold at any hint of trouble.

 

One thing I noticed was that my body a few weeks in just seemed to adjust to the smaller amounts.  I suspect that my body is in some ways adjusted to continually expecting a smaller amount now.  Wish there was a way to know for sure what's going on in our brains and bodies during this process, especially with drugs like Lamictal that seem to have so many trickle-down effects on different neurotransmitters in the body. 

 

I certainly feel like the slow method is helping me - and that keeping my 2 meds at the same balance point with each other is an important piece of the puzzle too.  At one point I had them quite a bit out of balance when I was doing just one at a time, and I found that as they got closer to being in balance, the overall withdrawal would be less and less even right after a decrease.  It's too bad there's no way to know these things ahead of time. 

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ChessieCat
11 minutes ago, LightQueen said:

Wish there was a way to know for sure what's going on in our brains and bodies during this process

 

Yes, this frustrates me too.  It would make it so much easier.

 

It sounds like you are very attuned to what is happening and are being very patient.

 

Please be aware that many members find that the lower their dose gets the slower they need to go, reducing less and/or holding longer.  Why taper paper: dose-occupancy curves

 

When to end the taper and jump to zero?

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LightQueen

Thanks Chessie.  I have been looking at some of the data for the SSRI's and had hoped to find something similar for buspar or lamictal but wasn't able to find anything.  Heck, I've had difficulty locating confirmation that lamictal influences glutamate because my psychiatrist insists that it doesn't... (I know he's wrong based on what I've found - but haven't found a reliable resource to bring to him to show him he's wrong.) 

 

I know the curves don't tell the entire story, but they are a very useful puzzle piece and it would be nice to know if it holds true across the meds I'm on.  I've seen a few people say that 100 mg is the magic number for lamictal - but then I've also seen people say 200 mg was the magic number and that wasn't a big bump for me at all. Just goes to show how individual it all is.  

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