DSparrow: taper to avoid WD symptoms

[DSparrow]

It seems to me that the brain can only recover at a certain rate.  Any drop below the healing rate will cause greater wd symptoms with no benefit in the rate of healing other than that you have dropped the drug so much as to maximize the rate of potential healing.  First a person should run a test run to determine their rate of healing.  If a person drops 5% and heals -has no symptoms- within 5 weeks this is a healing rate of 1% per week or (1/7) 0.143% per day.  Maybe there are better formulas to be established but it looks like one can avoid withdrawal symptoms by multiplying the per day healing rate by the half life of the drug to get a rate of drop per time period (half life).  Looking at Prozac with a half-life of 6 days and slow healing rate of 0.143% per day one can drop 0.858% each 6 days without having major withdrawal symptoms.  Of course it is near impossible to work with numbers like this so one could do 1% drop over 7 days.  For Wellbutrin which has a half life average of say 24 hrs one can drop 0.143% per day.   For my 525 mg tablets this comes to 0.75075 mg drop per day (total tablet weight).  Since of course this is almost impossible to weigh one could do a 1 mg drop every two days.  I do not know how this would need to change down the road.  

[Altostrata]

Welcome, DS.

 

I've moved your post to our Introductions section to start your own Introductions topic, where you can ask questions about your taper and note your progress.

 

Here is information about our tapering protocol

 

Why taper by 10% of my dosage?

Why taper? Paper demonstrates importance of gradual change in plasma concentration

 

We have not found the half-life of a drug to be a guide in tapering; rather, it's individual tolerance of withdrawal symptoms.

 

If you have found you get withdrawal symptoms from a 10% reduction per month, it's very possible that a tolerable rate of taper for you is 5% or even lower, see

The slowness of slow tapers
 

What drug are you tapering? To help us out, follow these instructions Please put your drug and withdrawal history in your signature

[DSparrow]

My formula might work because each person would need to determine their own healing rate.  Half Life is important because the drug clears faster and so cuts will need to be smaller and a shorter time period.  I’ve been working with an excel spreadsheet and the pharmacokinetics of the drugs and have been doing my own tapering.  This seems to keep my daily reduction below My DAILY rate of healing.   I appreciate all the posts and even though I have just signed up.  

[Altostrata]

I'm glad your rate of tapering works for you.

 

How many drugs did you put in your spreadsheet? You might want to use search in the Introductions section to see how people are tapering those drugs.

 

What drugs are you taking now? Do you have any side effects? What are you tapering, what is your method?

 

To help us out, follow these instructions Please put your drug and withdrawal history in your signature

[DSparrow]

Thanks for setting up this website and all the work you do to maintain.

 

I am currently withdrawing from Prozac and Wellbutrin.  I seem to be extremely sensitive as a 5% drop in either requires close to 5 week recovery time.  This puts me at 20 months of being in wd for EACH drug doing 5% a month and this does not even account for the tapering being more difficult when one gets closer to zero.  After months of frustration I considered my stategy stated above.  It seems to be working fine so far.  Mostly I was looking at my excel program of the pharmacokinetics of each drug to keep the per day reduction below my recovery rate of 0.143% (aprrox) per day.  This morning I thought I could make it a generic formula to see if it might help others.  Or throw it out for consideration and improvement.  With this schedule I feel pretty good.

 

I am currently at 88% of Prozac and 93% Wellbutrin of my starting dose.  Contrary to advice this website recommends I have decided to taper both keeping each below the daily threshold of MY 0.143% recovery rate.   Why they are both the same rate who knows.  I know they are both not exactly idependent of each other but it seemed to me if you had a broken leg and and broken arm they both still heal at the same rate and would be independent enough of each other.  I heal slowly on these drugs.  I don't want to wait seven years to begin tapering the next drug.

 

 

[DSparrow]

 

Also, this could so easily become my life obsession for the next ten? years.  I want to taper so that it is in the background of my life.  It really seems that this might work so that one can get off a drug with minimal withdrawal symptoms.    

[ChessieCat]

It's a good idea to Keep Notes on Paper and Rate Symptoms Daily to Check Patterns and Progress.  That way you may be able to recognise if you are starting to get withdrawal symptoms.  If/when this happens it is better to slow down and/or change to tapering one drug at a time.

 

You might find this topic helpful:

 

 

[DSparrow]

Thanks Chessie Cat.  My current rate of tapering means no withdrawal symptoms otherwise I will have to readjust.   Going from none to mild withdrawal symptoms won't be too bad.  I will just have to stop tapering for a week drop one drug one percent and calculate recovery time and wait a week and do the same for the next drug.  Readjust my tapering schedule to reflect.  Shrug.  I let you know how it works.?!?

 

It seems like I am new here but I have been reading incessantly this website and everything for months and have "enjoyed" being my own lab rat (NOT).  I had no idea what withdrawal meant.  I work in a lab as a research technician and so this stuff is kind of what I do for a living - researching and solving problems and in my free time at work and home my own.

 

I've been panicked and beaten regarding this issue.  I see some light at the end of the tunnel and wanted to share this tapering idea.  Who knows as with many seemingly ingenious ideas I may wake up tomorrow and wonder what was I thinking?

 

 

 

 

[DSparrow]

ChessieCat,  I’m 48 and I’m extremely sensitive to small amounts of tapering.  One drug will probably take 7 years.  I actually want to finish before I’m dead.  I don’t feel that I have a choice but to taper both at once.  I had no idea this is what going off antidepressants meant.

 

[ChessieCat]

We all want to get off them as quickly as possible.  However, it is better to go as slow as your brain will allow so as not to experience withdrawal symptoms which can sometimes cause the nervous system to become sensitised which can then affect many areas of a person's health and life.

 

I experienced extreme withdrawal symptoms when I first tried to reduce my Pristiq from 100mg to 50mg when after 3 weeks of extreme cog fog (even walking took all of my concentration) I was unable to type (been a professional typist for 40+ years).  I took extra Pristiq as suggested by SA and after about 4 hours I was able to type again.  I had a benchmark so I knew it was caused by the lack of drug.  I've since been following SA's tapering method and only experience minor withdrawal symptoms.  I'm now down to 6.5mg.

 

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[DSparrow]

My rate which I indicated is super slow and will take me years to get off not accounting for the fact that I will have to readjust as I get closer.  I suspect it will take 7 years.

[ChessieCat]

One of the mods created his own method of tapering:  the-brassmonkey-slide-method-of-micro-tapering

 

[DSparrow]

CheesieCat,

 

I’m eternally grateful for this site.  I’ve read it extensively. You all have done so much to keep it up.  I’ve read this link over and over and probably over.

 

Maybe this solution only works for me better than others.  I just wanted to share.  I’m super sensitive.  It seems to more sensitive than even the sensitive.  I will be able to adjust my tapering to 0.143% per day of my current dose in the future.

 

This website has already helped me so much!

 

 

[DSparrow]

So if you look at tapering one percent all in one day you can see the circled values my drop in drug exceeds my ability to recover.  I will have withdrawal 5 of the 7 days.  I am the example here using my recovery rate.  If you look at tapering 0.2% on Monday, Tuesday, Thursday, and Friday each you have the circled values where I exceed in ability to recover from the drop every day and will have no withdrawal symptoms.  Which is in fact what I have observed. 

 

 

 

[ChessieCat]

I'm very pleased that it works for you.  However, we have many members here who would be unable to deal with measuring a different dose every day and deal with complicated maths.

 

For me, I can only taper my drug by getting Pristiq compounded into capsules so I am very limited how I can taper.

 

1 hour ago, DSparrow said:

 I’m super sensitive.  It seems to more sensitive than even the sensitive.

 

This may actually be because you are tapering 2 drugs at the same time.  Have you considered tapering one reducing by a higher amount for a month or two and then tapering the other drug?  The time to get off would probably end up being the same.

 

Personally I think you are making it way more complicated that it needs to be, but if you are happy doing it that way and it works for you, then keep doing it that way.

 

And please remember to create your drug signature:

 

7 hours ago, Altostrata said:

To help us out, follow these instructions Please put your drug and withdrawal history in your signature

 

[DSparrow]

It’s easier than dealing with withdrawal which will be years and years.

 

[DSparrow]

Obviously this would not be something the average person would want to do I was just supporting my first statement but whatever.  My input is not wanted that’s fine.

[DSparrow]

I’m sure there could be an easy program made to calculate a tapering schedule based on ability to recover and half-life that you just plug in.

[ChessieCat]

It's not that your input is "not wanted", it is just that it is probably much too complicated for many of the members of SA, some of whom are struggling just to get through the day.  I am only experiencing mild withdrawal symptoms.  My compounded capsules are coloured for the different doses and I have also written clearly on the bottles and the lids in permanent marker what the doses are.  When I made a reduction recently I accidentally halved my dose for 4 days because I had picked up the incorrect bottle.

 

Some members are counting beads, some are doing liquid tapers and having to measure using a syringe, and others are crushing their tablets and weighing their doses.  Having to change the amount every day just adds an extra thing for them to worry about.

[DSparrow]

 

I was super excited after suffering months of withdrawal symptoms to have found a solution and wanted to share in case it could help someone else.

 

 

[DSparrow]

Maybe you guys don’t like success stories?

[Altostrata]

No, we're happy to hear you've ascertained your tolerance for dosage reduction and have developed a tapering method that works for you.

 

As a logical person, you know what a study of N=1 means. I don't believe your conclusion that tolerance for dosage reduction is based on drug half-life is correct -- rather, it's more likely related to receptor occupancy and individual neurology. But you have found a rate that's right for you, and that is a good thing.

 

As Chessie said, most people here could not handle the math or the measuring involved in your method, so we keep it simple and recommend dosage decreases monthly rather than daily. When people are very sensitive, as you seem to be, we recommend micro-tapering, which can be tiny decreases at smaller intervals, see Micro-taper instead of 10% or 5% decreases

 

You may wish to send a personal message to @DoctorMussyWasHere, he is developing a tapering calculator. It seems you are of like mind.

 

Please let us know how you are doing.

[DSparrow]

Obviously I am just me and I can’t test this on others.  

 

I think half half life is important.  One would only need to take the say 1% per week taper and cut it into two per week of 0.5% and 0.5% to see if it helped if it was for a drug with a short half life.  You only need to look at the charts I posted to see that this is true.  Yes, only I have experienced withdrawal on chart one 1% drop of Wellbutrin vs no-mild symptoms with separate cuts during the week.

 

Nothing here is contrary to anything you all have suggested.  It may be only of interest to the Uber sensitive where the time to attend the cuts will be worth the reduction in withdrawal symptoms.

 

I did the math last night I’m looking out like over 8 yrs to get off these meds.  I’m not strong enough to handle that many years of withdrawal and actually keep my life together.  

 

 

 

 

[DSparrow]

You all can poo poo new ideas.  You all are in charge and perhaps you like the dynamics of people being victims and you all the rescuers.

[DSparrow]

Yes, these are ideas.  I would not expect anyone to endorse without further consideration and others finding the ideas interesting enough to try.  Just ideas.  I don’t know why you find ideas bothersome.  You have put this post on a my profile so it is not there as advice for tapering anyway.

 

[DSparrow]

From what people write about withdrawal and using caffeine and alcohol it seems to fit that the brain really is micromanaging everything day by day hour by hour.  This also explains why people have the waves and windows.  The brain really is continuously adjusting.  It also makes one think that alternating between one whole pill one day and a half the next does not work well.  This is also my experience although not with anything near that spread.

[DSparrow]

Thanks anyway for the website and all.  I’m sure my irritation comes through even typing so ....  sorry.

 

 

[DSparrow]

I work in a lab that does nutrition research with human volunteers.  We also have a neuroscientist who works on our floor.  Maybe I can get my PhD studying withdrawal but with the lack of research regarding withdrawal etc I’m not sure it would ever get funded.  Plus I wouldn’t want to be responsible for weighing out someone’s drugs if that could even be possible.

[DSparrow]

How will things change if no research is done?  I suppose you are the moderators of new ideas so that won’t work either.  

 

It may not be useful what I have to share.  Change won’t happen without new ideas.  

[Altostrata]

4 hours ago, DSparrow said:

From what people write about withdrawal and using caffeine and alcohol it seems to fit that the brain really is micromanaging everything day by day hour by hour.  This also explains why people have the waves and windows.  The brain really is continuously adjusting.  It also makes one think that alternating between one whole pill one day and a half the next does not work well.  This is also my experience although not with anything near that spread.

 

That is the model that we are working on. It isn't the brain that's micromanaging everything, it's the entire neurological-hormonal network with constant feedback loops and regulatory systems making adjustments. That is what neuroplasticity means.

 

When you look at the complexity of that system, which is shaped by individual genetics, you can see why half-life is not the determining factor in withdrawal. Rather, it's the ability of the network to adapt to changes.

 

3 hours ago, DSparrow said:

I work in a lab that does nutrition research with human volunteers.  We also have a neuroscientist who works on our floor.  Maybe I can get my PhD studying withdrawal but with the lack of research regarding withdrawal etc I’m not sure it would ever get funded.  Plus I wouldn’t want to be responsible for weighing out someone’s drugs if that could even be possible.

 

Research is very welcome. Please see our From journals and scientific sources forum for published papers.

 

4 hours ago, DSparrow said:

I did the math last night I’m looking out like over 8 yrs to get off these meds.  I’m not strong enough to handle that many years of withdrawal and actually keep my life together.

 

You are likely stronger than you realize.

 

To help us out, follow these instructions Please put your drug and withdrawal history in your signature

[DSparrow]

I've seen many referrals to half life and effect on withdrawal symptoms.  Here is one. 

Antidepressant.pdf

[DSparrow]

[DSparrow]

Specifically

 

The Half-life issue The severity of the discontinuation syndrome is not the same for each SSRI. It seems to be related to the drug’s half- life. The shorter the half-life the quicker the drug will be eliminated and the more common is the discontinuation reaction (Coupland et al., 1996, Judge, Quail & Jacobson, 2002). To appreciate the impact of the different SSRIs it would be useful to be aware of their respective half-lives. Unfortunately data on the half-life of each SSRI are not readily available in children. Data from adult studies on the other hand indicate a wide range of values for each SSRI and can only be shown as approximations at the very best (Table 1). Fluvoxamine seems to have the shortest half-life of all SSRIs and as such it would be expected to have a higher incidence or severity (greater number of symptoms) than paroxetine, and fluoxetine would have the least. However, many reports indicate that the most common or severe reactions occur with paroxetine, intermediate ones with fluvoxamine and sertraline and the least common or severe ones with fluoxetine. One randomized double blind placebo controlled study using a 5 day period of treatment interruption with placebo substitution reported that the worst symptoms occurred by the end of the fourth day. Paroxetine was associated with 13 symptoms out of a 17 item scale, 3 out of 17 for sertraline and up to the fifth day no symptoms for fluoxetine (Haddad, 2001). Also the half-lives of medications could be shorter in children as they metabolize drugs faster. This could mean a different presentation in children but no such difference was documented in the case of 6 children, one of which was on sertraline, 3 on paroxetine and 1 on fluvoxamine (Diler & Avci, 2002). It has been reported further that the elimination half-lives for sertraline and desmethylsertraline are similar to adult values with no pharmacokinetic differences seen after parameters were normalized for body weight (Alderman et al., 1998). At the same time it is also mentioned that the average half-lives of paroxetine in children after a 10 mg dose is 11.1 hours, nearly half that of the adult which could make them more vulnerable to experience discontinuation symptoms within a short time (Diler et al., 2000). This does not seem to be quite the case and more clarifications are needed for a better understanding of the half-life issue and its implications.

[DSparrow]

 

 

The future of tapering meds.

[jozeff]

Hi dsparrow,

 

Welcome. I feel the concern Alto mentioned about people confused by meds enough not wanting to calculate a lot of stuff.

 

However, I like your explanation/theory about WD. I'm an analytical chemist myself and I love calculating things.

 

I have been trying to make a tapering schedule based on receptor occupancy but this is not easy.

 

 

I started a citalopram taper in April 2018 and decreased 0.1 mg every day from 25 mg. After 85 days I crashed so I stayed on 16.5 mg for a couple of weeks. I felt so bad that I updosed to 18 mg to feel better. That didn't really help because my body had to get used to that dose also. I'm on 18 mg citalopram now since August 14th 2018. Feel pretty stable....not good but stable. Some good days, some bad ones but not extremely anxious or depressed like in my taper.

 

Calculations are beautiful but we have to listen to our feelings. Last week I felt very depressed although according to my calculations I would be pretty stable.

 

If I'm correct you want to try a slow taper and make it faster until you get WD symptoms and consider that as some sort of baseline. This sounds ok but it's hard because the receptor occupancy changes also. Some symptoms might appear a few weeks later than others which complicated things.

 

I want to start brass monkeys slide method soon. I'm thinking about 2.5% per week with a 3 week hold. But, I need to be absolutely as stable as possible before I start tapering again.

 

id like to hear more of your tapering schedule. Can you send me an example of your sheet?

 

cheers 

 

 

jozeff

[DSparrow]

Most likely any technique that helped people taper would be more useful it was in a formula sheet that people could input numbers if it was effective/useful tapering method.  Yes,  math is great but humans are humans and healing is not exactly predictable and nor are all the variables accountable for.  Food can affect CYP enzymes and thus drug concentrations or sleep or stress and so how could you completely predict an outcome.  I was just hoping for a plan that would useful and then correcting the rate of tapering accounting for Sert occupancy.  I could not quite understand what b was in the formulas of sert occupancy and figured than I would use a taper rate of X established at beginning of tapering such that 20 to 10 mg would be 1X, 10 to 5 mg would be 1/2 X,  5 to 2.5 mg would be 1/8 X and then 2.5 to 0 would be 1/16 X.   Just for rough calculations.  Pretty much one could 1/2 the concentration of the drug for 10 to 5 mg using microcrystalline cellulose add twice as much to the gel capsules and keep tapering at 1 mg per week if your taper rate was 1 mg per week from 20 mg to 10 mg.  Yes, like you say that is the plan.

 

It is really simple to use excel to look at the an estimate of the pharmacokinetics of a drug.  Use a formula to consider body dose = today's dose + Yesterdays accumulated dose - yesterday's excretion (0.5 *  1/half-life).   Copy the formula until you get steady state for body dose.  Once you have the steady state you can start decreasing dosage and see how it affects body dose over a time period.  Of course we do not really know what the half life is in a particular person but we do have averages available online.  We also do not know if half-life within an individual varies from day to day.  Also,  this does not account for daily fluctuations which of course exist.  Maybe I should study pharmacokinetics more.

 

Here are my calculations.  Top is Prozac and bottom is Wellbutrin.  I can't say I intended this to be viewed by anybody.  Since you are an analytical chemist it won't look too foreign to you.  My husband is an analytical chemist here at Utah State University.   

 

I do math better than I explain what I mean.

 

Thanks for your reply!

 

Oh it seems for long term tapering if I want no withdrawal symptoms I'm at about 1/2 of what I call my healing rate of 1% per week.  1 mg (total weight) of Prozac per week and 1 mg (total weight) of Wellbutrin every 3 days.   I still think if you were going to max a cut in drug one still might be best dividing a 5% cut up to minimize symptoms.  Of course the amount of cut will give you different withdrawal symptoms.  So if I cut Wellbutrin enough to experience mild withdrawal I end up emotional which to me is worse that a major cut.  Of course if I make a major cut I still have that window of feeling emotional as I recover.

Prozac Pharmicokinetics2.xlsx