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The Brassmonkey Slide Method of Micro-tapering

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brassmonkey
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The Brassmonkey Slide Method

 

Starting a taper can be a very scary proposition.  I’ve heard is mentioned repeatedly by our new members and even by members who have been on extended holds and are about to restart. The overwhelming concern is fear of the symptoms that can be unleashed by reducing the drug in question.  I was as bad as anyone else, I was scared to death before I started my taper, and just for that reason.

 

Most of us try to research our taper before we start, so we can make a plan and have some idea what we are getting ourselves into. That research often includes reading a lot of other people’s stories, which can be very upsetting.  This can be a source of a lot of misinformation, out of context statements and vivid details that are hard to ignore.  Which is why we have a large number of forums that give detailed information of how, when and why to taper.

 

The symptoms that are experienced during a taper can be far from pleasant and keeping them at a minimum is a prime goal of any taper plan. With this in mind, the protocol of reducing a person’s dose by 10% of the previous dose every four (4) weeks was established.  Over the years it has proven to be a good starting point and has been very effective for many people.  It does, however, prove to be too harsh for others.

 

The second option is the “micro-taper”.  This involves reducing a tiny amount every few days over a very long time.  It does a great job of reducing symptoms but is very tedious and takes a very long time to complete.  There needs to be something in between.  Something that can reduce the effects of the symptoms and yet doesn’t take forever to complete.  This is where the Brassmonkey Slide Method comes in.

 

The idea behind the Brassmonkey Slide Method is to maintain the speed of a standard 10% taper while reducing the symptom load by taking the reductions in smaller bits.  When I was researching my taper, I observed that there was a large hit of symptoms that occurred several days after the reduction was made.  These symptoms would then peak and decrease over the next several weeks until the person would return to an average state of feeling bad.  My idea was that if the reduction were taken in smaller pieces fairly close together you would experience reduced symptoms for a shorter period of time and by doing reductions back to back, as the symptoms resolved, a person could maintain a 10% reduction and experience reduced symptoms.

 

The basic Brassmonkey Slide Method consists of four (4) weekly reductions of 2.5% in a row with an additional two (2) week hold.  This gives a total reduction of 10% ever six (6) weeks.  Although it isn’t the standard reduction plan it is very close.  The extra two (2) week hold is very necessary to let the cumulative effects of the four (4) reductions settle out and things return to baseline before attempting the next reduction.

 

So, the reduction schedule looks like this:

 

            Week 1 reduce 2.5%

            Week 2 reduce an additional 2.5% (for a total of 5%)

            Week 3 reduce an additional 2.5% (for a total of 7.5%)

            Week 4 reduce an additional 2.5% (for a total of 10%)

            Weeks 5,6 Hold at the last reduction level

 

This schedule proved very effective for the duration of my taper and has been used by many others with great success.  But, it’s not the only way to do it.

 

Some people find that even on this schedule the symptom spike after each drop is just too great.  For them the answer has been to take even smaller reductions.  Any combination of four (4) small reductions and a hold can be used. A reduction of 1.25% a week will yield a total drop of 5% or a reduction of 0.625% would give a total drop of 2.5%.  A very popular method is to reduce by 1% a week. 

 

We need to keep in mind though, the lower the reduction percentage the longer the taper will take to complete. The half-life of a standard 10% taper is six months.  Meaning that six months from now you will be at half of your current dose. If the taper is reduced to 5% the half life doubles to a year. Like wise a 2.5% taper would have a half-life of two years.

 

No matter what the reduction rate is it is very important to maintain the two (2) week hold every round of four (4) reductions. The symptoms that we feel after a drop are only a small part of what is happening to us.  Psych drugs work by making physical changes to the body.  As we taper these changes need to be undone in an orderly manner, so the body can continue to function the way it is meant to.  If we don’t allow time for these changes to be made properly they pile up and pile up until there are just too many of them.  The body then gets very confused and a crash occurs.  That crash will take a long time to correct and stabilize.

 

This behind the scenes repair work is one of the keys to the Brassmonkey Slide Method.  By making smaller reductions the bodies “to do” list is kept to a manageable size and most of the tasks can be completed before the next reduction happens.  Giving the body an extra two (2) weeks helps make sure it has enough time to get it all done. If the reduction is too large then the “to do “ list is also quite large and the body has a much tougher time getting started on the jobs and figuring out what to do first.

 

Another benefit to the Brassmonkey Slide Method is that it feels like it is very proactive.  I see a lot of comments from members who feel like they are not doing enough to help themselves get better.  Making any decision and sticking to it is being proactive with a taper but the long periods of time between decisions can cause people to lose track of that.  By making a controlled reduction in dose every week it makes it appear that things are progressing faster, even though the total reduction is the standard 10%.  This can be quite a boost for people who “want to take control of the situation”.

 

With all these changes being made it is a good idea to keep written records.  This will help track your progress, but it will also help keep things from getting confused.  With a constantly changing dose it is very easy to lose track of where you are and start making mistakes.  The records don’t have to be elaborate. I tracked the date of the reduction, the amount of the reduction, the strength of the dose in mgai and the weight that I would measure on the scales in mgpw, on a weekly basis.

 

Mgai, milligrams active ingredient, being the strength of the dose starting with the full strength listed on the bottle and reduced by the percentage of the reduction each week, i.e.33.2mgai.  While mgpw, milligrams pill weight, being the weight of the dose that is measured on the scales, starting with the weight of a whole tablet and decreased by the percentage of the reduction each week, i.e.265mgpw.

 

Example: October 23; 2.5%; 33.2mgai; 265mgpw

 

As with any taper it takes a long time to get off these drugs.  Using the Brassmonkey Slide Method is a way to keep that time as short and as painless as possible, while maintaining a feeling of control and allowing your body to make the changes necessary to heal in an orderly fashion.

 

See also:

Micro-taper instead of 10% or 5% decreases

Making a liquid from a tablet or capsules .

Using a digital scale to measure doses.

Edited by Altostrata
updated, added paragraph break and clarification

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wantrelief
1 hour ago, brassmonkey said:

No matter what the reduction rate is it is very important to maintain the two (2) week hold every round of four (4) reductions. The symptoms that we feel after a drop are only a small part of what is happening to us.

Hi Brassmonkey - When you state the importance of a two week hold every round of four reductions, are you referring to folks doing the Slide method or for any taper? 

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Gridley

This method is working for me.  Using it, I've gone from 20mg Lexapro to 7.2mg  in 16 months with tolerable WD symptoms and no need to updose. I rate my symptoms daily, with 0 being very mild symptoms and five being extremely bad symptoms, and my log has mostly 0's and 1's, an occasional 2, a few 3's, maybe one 4 and no 5's.  I plan to use it to taper Imipramine when the time comes.   

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Snowyowl16

I have been reducing by 2.5% weekly because the 10% drop made me feel sick for almost a week after the drop. Using the 2.5% drop I have only minimal symptoms. I hadn't thought of the 2 week hold however. Hmmmmm

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brassmonkey

Hi Wantrelief--  in this case it is specific to the people using the Slide Method.  It is however, a good idea to throw in a hold now and then when using the standard 10% taper also.  especially of you are making reductions every four (4) weeks.  This is due to the reasons I gave above, there has to be enough time allowed for the healing going on in the background to get done.  Otherwise the "to do" list gets out of control and people lose control of their taper.

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StarEyes

Thank you for this, Brassmonkey.  You are exactly right: I did feel scared to start my taper, especially after reading other people's stories. It is encouraging and reassuring to know that your individual take on the slow taper idea has helped you and Gridley. Because I have had such bad experiences in the past trying to get off antidepressants, I have decided to to go a step slower and cut  2.5% of the Lexapro (mgpw) every two weeks, for a 5% reduction each month. If I'm able to make it to 10mg, I will try a nice long hold of at six months to a year to make sure I'm stable, i.e, I'm not going to go to freak out and stop sleeping.

 

I'm on week two. I get that this will take years if I'm able to complete it,  but it's the only way I'll be sure I gave my brain the best possible chance to recover. If I stop sleeping on this gentle of a taper, then I know I need the drug to function, much as I'd love to be rid of it.

 

 

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Centime

Thanks for all this info, Brassmonkey. Very useful. I’m going to try your method.

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Rabe

Yes thank you for the really detailed account brfssmonkey.  I am going to take those thoughts to my doctor.  I finally dropped the Viibryd by 5%  yesterday...was terrified after December!  But made it through yesterday...didnot do very much and actually got out today.  The anxiety and headache thus far have been the only bad things...I remember you saying it takes 4 days for the body to get to a steady state again so will feel better after 4 days...is that right?  

Can the 2.5% be done with the Viibryd as well...any of the medications?  Thank you!

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Rabe

Also wondering, I was going to hold for 4 weeks after this 5% drop but am wondering if I can drop again sooner?  I had started some trauma work but gratefully Step said that is discouraged during WD...so I am stopping.  I had such an awful awful number of days after it!!!  Sat at the lake and cried and wanted to quit! Yikes!

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Rabe

Shep not Step!  Whoops!  Sorry

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Rabe

I'm sorry...I forget where I am and that I ought to be on my own thread asking questions!!!  Am going there to do so.

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brassmonkey

That's one of the nice things about it Rabe, the Brassmonkey Slide Method can be used with any medication that you can taper. We have people tapering ADs, APs, PPIs, and Benzos. It doesn't have to be just tablets either, liquids can be reduced in the same manner.

 

Four weeks between reductions in the minimum recommended hold period.  The body is doing a lot of healing in the background that we don't even notice, but if that healing can't keep up with the pace of the reductions it builds up and builds up until the body can't keep up and goes on strike.  That strike is usually in the form of a crash which will take months to stabilize from before a taper can be restarted.  In the long run it ends up taking more time to try and go faster then it does to go slowly and it can be a lot more painful.

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Rabe

Thank you brassmonkey....that makes SO much sense because it all happened.  Cannot understand why the doctors don't seem to know any of this...but grateful that people here do.  I am very grateful for you thoughts.  I did get 30 of the compounded 9.5mg Viibryd but was thinking if this goes ok I would drop another 5% in two weeks...but just as you said, my rapid taper by the doctor in September has left 8 months of not tapering.  We would have been further ahead or just as far ahead had it not been done.  Thank you for that insight.  I am grateful!

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DoctorMussyWasHere

This method sounds excellent, thanks BrassMonkey. I'm following this topic.

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Brooke57

Thank you! I’m going to try this. I have a question and sorry if it has been answered and I missed it. After I complete the first taper of 10%, for my second taper do I calculate 10% off my original bead weight (I’m weighing beads) or the weight with the first 10% gone?

Thank you :)

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brassmonkey

Hi Brooke-- The 10% calculation is taken off of the dose that your are just completing, which is referred to as the "previous dose", or as you stated the weight of the first 10% gone.

 

Welcome to SA.  Would you please start a thread in the Introduction forum and tell us about yourself.  Once we get to know you we an offer more specific information and support.

 

Brassmonkey

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Brooke57

Ok, thank you!

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Moonpie

This may seem like a silly question, but I am not a math whiz. I have been reducing my Ativan by weight. Next will be Lexapro. You're method sounds great. I am going to try it. Question is what do I multiply The Weight by to reduce it to 2.5% a week. The weight of my 10mg Lexapro is .169 M mg.  Thank you. Moonpie

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StarEyes

Hi Moonpie,

 

I had trouble figuring this out at first, too. To reduce by 2.5%, you would multiply your full dose of 16.9 grams pill weight by 97.5% (.975) which equals 16.47. Then, the next time you reduce you'd multiply the 16.47 by 97.5% again, and so on.

 

Beware, though: weights of the same medication can vary significantly.  I initially weighed my 20mg Lexapro pill, and it weighed 25 grams. So I cut from there. Later,  I found a post saying to be sure to weigh at least several of the pills and take an average weight. It turns out my Lexapro varied from 25. 2 to 25.8. By cutting 2.5% of 25 grams I may have inadvertently made a 5% cut instead of 2.5%, and I did feel weepy those two weeks. So I held the 5% until 4 weeks were up, since I'm doing a 2.5% cut every two weeks.

 

So far, so good. Good luck on your Lexapro taper.

 

StarEyes

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Rabe

Brassmonkey I have a question.  What if your worse symptoms seem to come around 12 to 14 days or so after you decrease?  Do you still drop every week?  I get this kind of almost too good feeling the first week usually...maybe that will change...and then after bout another week symptoms start up.  Thank you!

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bubbles

Hi @brassmonkey

 

Do you vary the  method according to the half life of the drug? I'm wondering about applying this to the sertraline.  Sertraline has a 23-26 hour half life but also has an active metabolite with a 66 hour half life. I *think* that means that the sertraline is at steady state after two weeks. I'm thinking that a pattern could be:

 

Start 8.1mg

week 1 7.9mg

week 2 7.7mg

week 3 7.5mg

week 4 7.3mg

week 5 hold

week 6 hold

 

That is 10%, over four weeks, then a two week hold. However, it would take the two weeks to get to steady state, which means that there is almost only one week at the new normal before starting over again.

 

I'm wondering if something like this might be better:

 

Start 8.1mg

week 1 7.9mg

week 2 7.6mg

week 3 7.3mg

week 4 hold

week 5 hold

week 6 hold

 

Or, is it a trial and error sort of thing?

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brassmonkey

Hi bubbles-  Good questions.  What I have described is the baseline model for the Brassmonkey Slide Method.  It's a jumping off point for people to modify if it is required. Longer holds are always a good thing. Taking into account the half life of a drug and its time to steady state are certainly factors that should be taken into consideration when designing a personal taper. The dynamics of paxil and  sertraline are almost identical so there shouldn't be any problem using the same method for both of them.  Your second example is a quite workable plan.

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brassmonkey

Hi Rabe-- is that the symptom pattern for doing a full 10% reduction at one time?  The symptom pattern will be different when making a series of smaller tapers on successive weeks.  Possibly moving the drips to two weeks apart might help.  It would slow things down, but symptom reduction is the object not speed of taper.

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brassmonkey

Moonpie and StarEyes-- that's the way it works.  Multiply your current dose by .975 to get the weight of your new dose.

 

There is going to be a small variation in the total weight of the tablets, it's a manufacturing thing and is very hard to work around.  However, the difference is very small.  When you work out the AIC (active ingredient concentration) of the drug, divide the strength by the total weight of the tablet, you will find that the difference is insignificant. In your cans MoonPie the AIC is .017 mg or written out the long way 0.000017 grams. Compare this to your full strength of 0.010 grams and you can see that it isn't a whole lot.  Unless a person is extremely sensitive to the drug it is a non factor.  The way around it is to crush the tablets into a fine powder and only weigh out the amount you need from a supply pile.  Also work with an average weight calculated from a number of tablets to determine your starting dose and go from there.

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Surfchick

hi, i am new here. I am hoping to change my Zoloft prescription to liquid Rx so i can start this micro-taper! I am so grateful i found this site. 

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SkyBlue
42 minutes ago, surfingmidwife said:

hi, i am new here. I am hoping to change my Zoloft prescription to liquid Rx so i can start this micro-taper! I am so grateful i found this site. 

Hello and welcome. : ) Please start a thread in our Introductions section and tell us more about yourself.

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Moonpie

Thank you Brass Monkey and Stareyes.  That helps.  I have one more dose of Ativan to taper. I am almost done with tapering my second dose. And I already have the remaining dose half of the original weight. I was very sensitive to Ativan and such a blessing and helping me. I have had to taper it .001 in weight every 4 days. I am tempted to try this with my remaining dose. My math is not great. My Lexapro weighs .169. When I multiplied it by the .975, it came out to .165. And I understand I would hold that for a week before reducing another dose. Is that correct?. Lexapro as I am to the Ativan. After that I have a small dose of Buspar to taper and I Will Be Drug Free. But that is looking a couple of years ahead. I appreciate your help so very much thank you

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brassmonkey

Hi Moonpie-- yes, your new dose would be .165. Then for your reduction next week start with the .165 and multiply by .975.

 

Brass

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Blandell

I want to use this method and keep the liquid in the fridge. I was told perhaps ok for 3 days in fridge. 

I guess I’ll need a very accurate oral syringe?

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mammaP
18 hours ago, Blandell said:

I guess I’ll need a very accurate oral syringe?

Yes you will need oral syringes, I have 10ml 5ml 1ml all from Amazon. You can get them from pharmacies. 

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ryan1982

@brassmonkey

 

Hey BrassMonkey- I've followed you for quite some time and I really enjoy the information that you give.  As you can see by my taper, I went way too fast and I'm now (still) paying for it.  I'm at 4 MG of Lexapro and I'm on a really, really long hold to try and stabilize. I want to do the BrassMonkey slide whenever I do start as I want to ease my system into it.  Would you mind answering a couple questions when you have a moment?

 

1) How long will it take until I stabilize on 4 MG of Lexapro?  I've literally had this rollercoaster of symptoms and some days are OK, some are good and some are really bad.  Should I wait until I have a pretty stable month before I proceed down?  I took a little bit of magnesium glycinate (25 MG) and that threw my system off terribly so I'm in a pretty unstable place.

 

2) I modeled out what the BrassMonkey slide would look like for me at 4MG and it has me being completely at zero in 5.3 years.  That seems awfully conservative, especially from such a low dose.  Am I doing the math wrong, especially at the end?  Will it really take 5.3 years of my life to taper completely?

 

Thank you so much for your time and help!  I feel a bit isolated in this as no one else in my family really understands what I'm going through.  I really appreciate the support of this community and hope to give back one day as others have to me.  

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Blandell

I am on 10mg of Paxil and going to start lowering dose in a few days. 

I am having trouble doing the math for future decreases. Can anyone help? I am normally great at math but right now am feeling kind of stunned. 

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brassmonkey

Hi Ryan-- If you've been following my posts then you've probably already read it, but I talk about all of this in my essay Are We There Yet? How Long is Withdrawal Going to Take? 

 

There really is no way of predicting how long it will take to stabilize on any given dose.  In general it's best to hold for at least three months and then reevaluate the situation.  Many people will stabilize with a hold of three to six months but it's not uncommon for it to take longer.  Holds of over a year have been reported, but the stability eventually comes. It's a long, frustrating process.

 

My last post on the above link just happens to address this very subject.  For a quicker calculation, the half life of a 10% every four weeks taper is about 6 months. So if you were to start today in six months you'd be at 2mgai and in a year 1mgai. Following this progression you would be in a good position to make the jump to "0" in about three years.  The half life for a basic Brassmonkey Slide is a bit longer at 9 months.  Following the same progression you'd get to a jump point between four and four and a half years.  So taking the time required to stabilize and following a basic Brassmonkey Slide, yea, it will take about five some years to be drug free.

 

The thing is, it won't all be pain and suffering.  Once you're stable and following the taper your symptoms should be quite manageable and decrease as the slide progresses.  A number of our members report greatly reduced symptoms once the Slide is underway.  It makes it so that the taper is more routine than anything else.

 

Brassmonkey

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brassmonkey

Hi Blandell-- no problem with the math help.  We need to know the specifics of how you want to taper. What percentage decrease are you planning? Will you be using scales and dry cutting? If you're using scales, what is the average weight of your Paxil tablets?That will get us started.

 

Brassmonkey

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Blandell

At the moment I have several options for how to taper: liquid paroxetine; making my own liquid from 10 mg tablets; or a combo of liquid and tablet ie. halve tablet =5mg and then balance with liquid

I think I will start with 2.5% reduction for 1st week. If it is fine then will do again the next week, and then again...each week for 4 weeks and then hold for two weeks or more if I think I need to. 

So will be dropping 2.5% each time I reduce. 

Thanks for your help. This feels like a big step!!

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DoctorMussyWasHere

I've tweaked the taper calculator to handle floating point numbers.

 

Click the three-dot symbol at the bottom

Set Taper Percent to eg. 2.5

 

FP.png

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