misscathleen: taper

[misscathleen]

Hello,

 

I'm a 39-year old mom of 2. Been on lamictal since my 3-year old was born in 2014 and when I was diagnosed with postpartum depression (ppd). Wasn’t ever diagnosed with bipolar, but had bad experience with an SSRI and my pdoc suggested lamictal was the way to go. I had very mixed feelings because I was nursing, but I felt so terrible and needed something. I have two daughters and need to be available to them. I made it up to 225mgs and that’s when the last of the ppd symptoms subsided, which was morning anxiety. Been at 225mgs, taking my entire dose at night, for about 2 years.

 

Since all this started, I’ve had moodiness around the time right before or right after my menstrual cycle, which leads me to believe my symptoms were/are due to hormonal shifts. I’ve been talking about tapering for at least a year and my pdoc finally agreed. 

 

I started to taper with the help of my pdoc in late Feb 2018. She suggested to taper from 225mgs to 200. Did that for a few weeks and felt good so I started a little more aggressive taper by myself. Moved down to 175mgs and stuck there for 2 weeks, still felt great. Tapered again to 150 and felt fine for 2-3 days and then (2 days ago) I was hit by a ton of bricks. Headaches, dizziness, weird sensations almost out of body, fogginess, morning anxiety, general feelings of blah. Last night I took 150 and then went back up to 175mgs by taking 25mgs this morning because I feel so awful. I plan to hold at 175mgs at night until otherwise suggested.

 

I found your site a while back and it made me aware of the importance of a slow taper. But then I was feeling so great I thought I might be one of the “lucky ones” and didn’t need to taper so slowly. Apparently not! So I’m back and committed to a slow taper even though I want to be off this medicine like crazy.

 

I’m looking forward to hearing any feedback, and I’m in need of help on how, mathematically, to taper. I get the 10% reduction over 4 weeks but the math confuses me. 

 

Thanks for reading this!

[ChessieCat]

Hi misscathleen and welcome to SA,

 

I think every member here hopes that they will be one of the "lucky ones".

 

I've included the link to a calculator spreadsheet.  However the easiest way to calculate your new dose is to multiply the previous dose by 0.9.  Example:  100mg x 0.9 = 90mg,   90mg x 0.9 = 81mg,   81mg x 0.9 = 72.9mg.  For this 3rd amount I would round up to 73mg.  Always round up, not down.  You would then calculate on the new amount so 73mg x 0.9 = 65.7mg, and round up to 66mg for ease of measuring the dose.

 

 

We ask all members to create a drug signature.  Please update it whenever you make a change.  Please keep it nice and simple.  We only need details for the last 2 years.  Date, drug and dose only, no symptoms or diagnoses.  The other years can just be an overview.  

 

This is the preferred format which is helpful for the mods.  Thank you.

 

A request: Would you summarize your history in a signature - ALL drugs, doses, dates, and discontinuations & reinstatements, in the last 2 years particularly?

• Please leave out symptoms and diagnoses.
• A list is easier to understand than one or multiple paragraphs. 

• Any drugs prior to 2 years 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.
• Link to Account Settings – Create or Edit a signature.Before you begin tapering what you need to know

 

I'm going to give you lots of links to check out.  Please don't feel overwhelmed, just work your way through them one at a time as you feel able.

 

SA recommends tapering by no more than 10% of the previous dose followed by a hold at that dose for about 4 weeks to allow the brain to adapt to not getting as much of the drug.  This is because psychiatric drugs create a physiological dependence, not physical like caffeine or nicotine.

 

Patience is needed to get off these drugs.  We suggest throwing out the calendar and listening to your body and your symptoms.  If after 4 weeks you don't feel stable, are unwell or life circumstances are a bit more stressful than usual (for example the Christmas period, winter time, or job change) it is better to stay at that dose for a bit longer until things settle down.

 

Why taper by 10% of my dosage?

 

Tips for tapering off Lamictal (lamotrigine)

 

Dr Joseph Glenmullen's Withdrawal Symptoms

 

Windows and Waves Pattern of Stabilization

 

How do you talk to a doctor about tapering and withdrawal?

What should I expect from my doctor about withdrawal symptoms?

 

Brain Remodelling

Video:  Healing From Antidepressants - Patterns of Recovery

 

Keep it Simple, Slow and Stable

Keep Notes on Paper

 

Rate Symptoms Daily to Check Patterns and Progress

Tapering Calculator - Online

 

The only supplements which SA recommends are Magnesium and Omega-3 Fish Oil.  Try a small amount one at a time to see how you react.  It is best to make only 1 change at a time.  It is also better not to start taking a complex vitamin because if you experience issues you will not know what exactly is causing it.  B vitamins can be stimulating especially B6.  hypersensitive-to-b-vitamin-or-b-vitamin-complex  If trying anything new, start with a small amount to see how you react and build up to the recommended amount.  

 

Even with a careful and slow taper you will most likely experience times of discomfort.  It is best to learn and use Non-drug techniques to cope

 

There are many existing topics and discussions on this site.  You can use the site search function on the main page of the site at the top right, or use a search engine and include survivingantidepressants.org in your search string.

 

As I said, lots of information, but I really want you to have what you need so you can have a successful taper.

 

This is your own Intro topic where you can ask questions and journal your progress.  We suggest that members visit each others Intro topics so that can support and encourage each other.

[misscathleen]

Thank you for the info. I updated my signature, but can’t see others from my mobile device so hoping it sufficient.

 

As I mentioned in my intro, with my initial aggressive taper, I started having morning anxiety when I went from 175 to 150mgs of lamictal after 2 weeks. Since then, I went back up to 175mgs and I’m holding there. I’m sure everyone’s symptoms are different, but I’m curious if the anxiety should be expected to subside being at the previous dose.

 

When (and if) the anxiety subsides, is that the sign I’m ready to do another (much smaller!) taper? What if the anxiety doesn’t subside? Do I go up another again to level off? I guess I’m wondering what should be my expectations about my symptoms while I taper and how to know when to change the dose.

 

Thank you for all the info!

[ChessieCat]

Try not to worry about what might happen or not happen.  Take one step at a time and cross bridges as you come to them, because worrying about something that may or may not happen is very stressful and it is better to stay as calm and patient as possible during this process.  Because you have been reducing too quickly it may take several months for things to stabilise.  Learning to accept your current state can help you to get through this without panicking and increasing your dose unnecessarily:  Acceptance and Acceptance and Mindfulness

 

These may help:

 

Stabilising - What Does That Mean?   

Withdrawal Normal Description

 

It can be helpful to keep notes on paper because you may be able to recognise small improvements which you may not notice.

[misscathleen]

Thank you. I needed to hear that to get my expectations in the normal range.  I often get too many steps ahead of myself. Perhaps the reason I was so aggressive with my first attempt at tapering. Too, it’s so easy for me to “awfulize” especially with medication. I have a fear that if a symptom comes up while I’m tapering, it’s a symptom of the disease versus a symptom of withdrawal. But what I’m hearing is that going slow will help reduce the symptoms. Slow and steady. 

 

Ive started a diary. I’m sure that will help. I’ll also take a look at the links you provided.

[Carmie]

Hi misscathleen, 

 

Just checking in to see how you’re doing. Sending hugs🤗

[misscathleen]

Thanks so much for reaching out! I was trying to update my info after the New Year but didn’t get a chance to do it yet.

 

Any how, I’m doing pretty well. Still tapering - slowly. I’m now on 106.25 mgs Lamotrigine. I’m feeling mostly good.

 

I’ve had some minor set backs where I’ve had to go back up to a previous dosage (like from 112.5 back to 125mgs) because I felt so awful. I had missed a couple nightly doses inadvertently and didn’t remember until morning. So I stabilized for a few months back at the higher dose. I’m back on my taper schedule however. My goal is to be down to 100mgs by my 40th birthday in February.

 

its been a long road since I started to taper from 225mgs but I’m headed in the right direction!

[Carmie]

Hi misscathleen, 

 

I’m so glad you’re doing pretty well. 

 

It’s not a good idea to miss doses, but because our brains are in lala land it’s easy to do. I suggest getting one of those Monday to Sunday pill boxes. Do you have one? That way if you’re not sure if you’ve taken your dose you can just check the box for the day, I’ve double dosed accidentally a couple of times as I couldn’t remember if I took my dose. 

 

Please don’t put a date on when you will finish your taper. You need to go according to how your body feels. I’ve learnt my lesson in this regard. 

 

You certainly are heading in the right direction. I managed to get myself down from 300mg of Seroquel to 7.5mg. It’s been a long journey, and I still have a long journey in front of me but I will get there. We both will. Take care💚

[misscathleen]

Lamictal Taper Questions- Scale /Math/Help!

 

In the past I was tapering lamictal by using a combo of 25mg pills and 100mgs pills and by making my best guess when cutting pills at what is a 1/2, 1/4 etc. When tapering from higher doses that seemed to work fine, but then I tried that method with tapering below 100mgs, and I’m sure I wasn’t taking a consistent dosage. 

 

I held at 100mgs for a long time and recently decided to restart my taper by dry cutting and using a scale. The 100mgs pills have a weight of .24g. I’ve tapered 3 times and currently at .175g of a 100mgs pill.

 

I’m thinking I would like to try to make a liquid suspension as I taper at lower dosages. I read it can be more precise. But since I’m now tapering by weight in grams, I’m not sure how I would work that out since I have no idea how my mgs I’m taking. Maybe there’s some math I could use to figure out that conversion?

 

Could someone share with me how to go about the best way to taper at lower doses after converting from mgs to grams? I read the different posts about tapering and making a liquid suspension and I’m still not clear on any of it. 

Edited October 22, 2022 by manymoretodays
merged to Introduction topic, title added

[manymoretodays]

Hi misscathleen, and welcome back, @misscathleen

I've merged your recent post back here to your Introduction topic.  This is where you post when you have questions regarding your case.  Do bookmark it or find a way to remember how to access your page.

 

5 hours ago, misscathleen said:

Could someone share with me how to go about the best way to taper at lower doses after converting from mgs to grams? I read the different posts about tapering and making a liquid suspension and I’m still not clear on any of it. 

 

You'll see the topic on tapering Lamictal here in your topic if you scroll up to your welcome and first post approval post.

 

And then, more on using scales is here:

Using a scale to weigh and measure doses(just click on the underlined passage, to get to the topic, and start at the first post)

This is a long topic, and of course ask more here when you have questions and need further clarity.

 

You can use an online helper to figure out mgs to grams.  I've done that before. mg to grams conversion   Most scales read in grams, and so the conversion is then from grams of pill weight to milligrams of pill weight. 

Keep in mind that the pill weight is not the same as the pill dose strength.  The weight is usually more than the dose strength.  Important stuff as you proceed.

 

Since you've been gone for awhile, you should also check your signature now(the portion below your post(s), and......if needed update that for us as well.

You just go to AccountSettings/signature/update edit and when done, be sure to hit the SAVE button at the bottom so it goes through.

 

Hope you have been doing well enough during your absence.  Take your time, getting re familiar with tapering and deciding how you want to proceed.  Ask away, right here in your topic.  Staff can help answer your questions, as they arise.

 

Okay, and best.

L, P, H, and G,

mmt