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Glosmom

Discernible patterns in the tapering process

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Glosmom

Most, if not all, of us on here keep notes or track symptoms, progress and tapering schedules.  Wouldn’t it be wonderful if we could combine them all in one big AI database and have it spew out the statistically significant data?  Until that comes to fruition, I wanted to share some patterns that I have tracked with my daughter’s anti-psychotic tapering progress over the last two years.  Maybe others have seen similar patterns? Or can share their noticeable patterns on the specific days or weeks when they occur from a drop in dose/ taper time frame.

 

So often in the throes of withdrawal agony we look for a way to ‘fix’ our current situation. We ruminate whether we should up dose, taper down, throw a supplement at it, add a different med …. In the hopes of making the current “pain”, better.  Pretty much I have thought of all those things except throwing in the kitchen sink in an attempt to ‘make it stop’ for her.

 

As it is often cited and discussed here on Survivingantidepressants.com, learning how to cope using non-drug techniques during these times is the best strategy.  Can knowing when you are in the middle of something awful, that what you are experiencing is actually a typical pattern others have gone through and will eventually subside…be of benefit to help ‘ride the wave?'  I vote, "yes it can."

 

The pattern that I have noticed for my daughter, Glo, is what I call the “Week Three Phenomenon.” This phenomenon became more apparent as her dose became lower.  Probably because she was pretty much ‘zombified’ on the higher doses and it was only when her level of alertness improved and just overall feeling better occurred that the ‘down patterns’ emerged more clearly.

 

Week Three Phenomenon occurs between day 15 and 22 after a taper. It shows up as Emotional Spirals, (typically Anger Spirals), Crying Spells, Agitation and increased Insomnia.  Week one and Week two have their share of symptoms but typically not these.  Actually those weeks have more physical symptoms and less emotional symptoms.  Additionally there is more “calm” in week 2. So one might think, “Ahh I made it through the rough parts of that taper” and then boom….not so much. But then by week 4…pretty much on cue for day 22 or 23…the calm returns.

 

Maybe this is Windows and Waves but maybe it is actually repair work going on from the drop in dose. Maybe there is really a methodical way the brain heals and it impacts certain areas of the brain in succession (the amygdala, hippocampus, frontal lobe perhaps)?  Similar to the old fashioned arcade Pinball Game only the “ball” pings the same areas of the brain in a repeatable fashion after a taper?

 

I am certainly only a mother observing my daughters behaviors and actions through this process so, no expert am I. Nor do I really know what she is feeling as she does not talk much any more.  However, I can count on these emotional spirals showing up on week 3 like clockwork. 

 

The other pattern I see relates to Menstruating Females.  This pattern is most discernible when one is having regular periods.  Glo went from amenorrhea in the beginning to irregular periods then to regular but shortened periods.  But every month when she is regular her symptoms go ‘off the charts’ during ovulation.  They last about 24 to 36 hours and occur mostly 14 days before the start of her next period.  She has ramped up pacing (I am assuming akathisia), chewing/jaw tension, agitation, insomnia and decreased level of alertness/communication. This same pattern emerges 24 to 48 hours before she starts her period. 

 

So what happens if my sweet beautiful daughter is in Week Three of a taper and ovulation or her menstrual cycle arrives? Well, if the general public, doctors or psychiatrists were around they would lock her up in a psych ward and “med her up” (to refer to words by @puthappinessfirst) 

 

Fortunately, I will not let that happen.

 

It is comforting to me to know these are patterns and that there is always calm after these storms; usually in the form of increased healing.  She is better now than she has been at any time on this medication.  She still has much healing to do. I still have patience to learn.  But we are getting through to the other side of being on this poison.

Peace to all who taper, Glosmom

 


2016 - Oct -Daughter started Risperdal (for steroid induced psychosis that never went away after stopping prednisone)

Nov - dose increases stopped at 1.5mg in Dec

2017 - Jan- weaned from 1.5 to 1.0 in 2 weeks then 1.0 to .5 in two weeks and then off. Feb. 3 weeks of increased psychosis, pacing, insomnia, other awful symptoms so late Feb  - Back on 1.5 mg Risperdal. May  - decrease to 1.25mg, two weeks later 1.0mg - symptoms started again. June - held steady at 1.25mg for 6 weeks and switched to liquid (3 ml syringe). July - started 10% taper every 3 weeks, October -  .8 mg, December - .7 mg .

2018 -Jan- 0.65 mg,  Feb- 0.59,  Mar-0.50, late April - .40mg, July- .36 mg, Aug - switched from 3 mL syringe to 1 mL syringe for more accuracy (her dad and i were not sure we were giving her the same dose when in between the 'dashes' on the 3 mL syringe.) Aug -.30 mg (3mL syr)/.44 mg (1 mL syr) difference due to med in the tip of both syringes). Sept- .28 mg (3mL syr)/.42 mg (1 mL syr). Oct - .16 mg (3 mL syr)/.30 mg (1 mL syr). Nov.- .06mg (3mL syr)/.20 mg (1mLsyr). Dec. - tip only/unmeasurable (3mL syr)/.10 mg (1mLsyr)

2019- Jan -.06 mg (1 mL syr), Feb- .025 mg (1 mL syr), Feb 27, 2019 - jumped to zero!!

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MRothbard

thanks. I wouldn't mind others chiming in with patterns they've experienced as well.


September 2014 to July 2015 - 20 mg Lexapro, 30mg Mirtazipine

 

August 2015 to November 2016- 10mg Lexapro, 30 mg Mirtazipine

 

Nov. 2016 to Nov. 2017 - 10mg Lexapro, 3.75 mg Mirtazipine

 

Nov. 2017 to Mach 2018 - 5mg/2.5mg Lexapro, 0mg Mirtazipne

 

Mach 2018 to Dec. 2018 - 0mg Lexapro, 0mg Mirtazipne

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papaloapan

Great post Glosmom


Nov/30/17 started Q-MIND (quetiapine) IR tablets 100mg 0-0-1. 

Dec/1/17 started pristiq (desvenlafaxine) 50mg tablets 1-0-0. Jan/4/18 started tapering pristiq by alternating dosages

Jan/5 & 6/18 changed to quetiapine XR 300mg. Jan/7&8/18 changed to quetiapine XR 150mg. Jan/9/18 went back to IR quetiapine 100mg 0-0-1.

Jan/14/18 started with 1.5mg melatonin 0-0-1, fish oil 1-0-1 and magnesium with calcium capsules 2-0-2.

Jan/20/18 went back to one daily pristiq 50mg 1-0-0

Feb/7/18 started neurovit 1-1-1 (glutamic acid 200mg, HCL lysine 150mg, sodium glycerophosphate 112mg & nicotinamide 30mg) 

?/?/18 started neurovit 1-1-0.   ?/?/18 started neurovit 1-0-0.  ?/?/18 started ginko biloba 40mg 1-0-0

Mar/12/18 at night started 15 drops of tramadol. Each drop = 2.5 mg of tramadol. Mar/13/18 to Mar/19/18: (7 days) 15 drops twice a day (15 drops in the morning and 15 drops at night = 15-0-15). 

Mar/20/18 (1 day): morning 15 drops, night 12 drops = 15-0-12. Mar/21/18 (1 day) 12-0-10. Mar/22 & 23/18 (2 days) 12-0-12. Mar/24/18 (1 day) 9-0-9. Mar/25/18 (1 day) 6-0-6. Mar/26 and 27/18 (2 days) 9-0-9. Mar/28 and 29/18 (2 days) 6-0-6. Mar/30 and 31/18 (2 days) 4-0-4. Apr/1/18 - Apr/5/18 (5 days) 6-0-6 . Apr/6/18 - Apr/10/18 (5 days) 5-0-5. Apr/11/18 (1 day) 4-0-4 . Apr/12/18 - Apr/18/18 (7 days) 5-0-5. Apr/19/18 (1 day) 4-0-4. Apr/20/18 - May/3/18 (14 days) 4-0-5. 

May/4/18 - May/18/18 (15 days) 4-0-4. May/19/18- Jun/1/18 (14 days) 3-0-4. Jun/2/18 - Jun/18/18 (17 days) 3-0-3. 

Jun/19/18 - Jul/7/18 (19 days) 2-0-3. Jul/8/18 - Jul/9/18 (2 days) 2-0-2 . Jul/10/18 - Aug/6/18 (28 days) 2-0-3.

Aug/7/18 - Sep/3/18 (28 days) 2-0-2. Sep/4/18 - Sep/13/18 (10 days) 1-0-2. Sep/14/18 - Oct/18/18 (35 days) back to 2-0-2, Oct/19/18 - Nov/16/18 (29 days) 1-0-2. Nov/17/18 didn't take neurovit and ginko. Nov/18/18 - Dec/6/18 (19 days) 1-0-2. (total in 1-0-2 49 days) Dec/7/18 - Jan/29/19 (54 days) 1-0-1. Jan/30/19 - Feb/1/19 (3 days) 1-0-2. Feb/2/19 back to 1-0-1. Feb/2/19 - Mar/29/19 (56 days) 1-0-1. Mar/30/19 started 0-0-1 

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Altostrata

Good points, Glosmom.

 

My theory about what happens is that when you make a reduction, because of drug half-lives, it can take some time for the reduction to completely register throughout the body. A drug's half-life means the amount of time it takes for half the drug to be metabolized and excreted by the body. However, there's still about half the drug left to be processed.

 

With its active metabolite, risperidone has a half-life of about a day (may be longer or shorter due to genetic variability).

 

As people get to a very low dosage, they may become more sensitive to reductions. It's possible that the small amount of drug is being metabolized faster than the higher dosage. Or, they are further down on the saturation curve and each reduction is felt more strongly.

 

Another factor in your daughter's pattern is that it might take some time for the nervous system to "realize" it's working with a lower amount of the drug. The entire body has to adjust. It chugs along on its settings for for a while, then gradually changes settings to accommodate to the lower amount of the drug. As you observed, your daughter''s brief rocky period a few weeks after a reduction indicates her system is adjusting to the lower dosage.

 

But we don't want this adjustment to be too difficult, that could throw the nervous system into a spin. Quite often, people make even smaller reductions when they are in the last phase of a taper to make the path even smoother.

 

It's quite common here for women to report worse withdrawal symptoms at times in their cycle. It may be a good idea to track that symptom pattern and plan decreases around it.

 

Congratulations on getting Glo down to such a low level of the drug. You've done an excellent job.

Edited by Altostrata
updated link

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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India

I can't seem to access the saturation curve. Is it a download? This is really helpful information.


1999:  Paroxetine (20mg). Age 16. 2007-2008: Fluoxetine (Prozac) for 1.5 years (age 25) Citalopram 20mg 2002-2005, 2009: Escitalopram (20mg), 2 weeks, (age 26) (adverse manic reaction)/*Valium 5mg/Temazepam 10mg 2010: Mirtazipine (Remeron)( do not remember dosage) 2010, 5 months.                     

2010-2017: Citalopram (20mg) (age 27 to 34) 2016: i.1st Sept- 31st Oct Citalopram 10mg , ii.1st November 2017-30th November 2017, Citalopram 5mg iii.1st December 2017- 4th February 2018, Citalopram 0mg, iv.5th February 2018- March 2018 Citalopram 5mg (10mg every other day) 28th February- tried titration of 5mg ( some adverse effects)

2018: 1st March 2018- 1st June Citalopram 10 mg (tablet form) /started titration 8mg , then 7 mg.2018: June 15th- 10th July Citalopram 10 mg pill every other day 2018: 10th July - 13th Sept Citalopram- 0mg  (CBD oil first month of 0mg, passiflora on and off) 2018 13th Sept Citalopram  2mg ,  approx 16th Sept 4mg , approx 25th Sept 6mg held.  2019: 11 Feb 19: 7mg (instant bad rxn) 12 Feb 19 6mg held 1 May 19 5.4mg held 5 Oct 19 5.36mg 22 Oct 19 5.29mg 30 Oct 19 5.23mg 4/NOV/19 5.18mg 12 Nov 19 5.08mg 20 Nov 19 4.77mg

(Herbal/Supplements since 1st September: Omega Fish Oil 1200mg, 663mg of EPA- 2 tablets a day, magnesium and magnesium bath salts)

I did not die, and yet I lost life’s breath
- Dante

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Altostrata

Fixed the link. It leads here

 


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Glosmom

Thanks so much for your thoughts and insight, Alto. I really appreciate it!   We most definitely steer any reductions in dosage around her menstrual cycle schedule once we realized the correlation.  Sometimes, unfortunately, due to her shortened cycle it was inevitable.  I did just post a comment in the SERT occupancy thread as it was sooooo obvious that the last decrease from 1.0 to .06 impacted a different set of receptor specific activity (a1 adrenergic versus 5HT2???).

 

I presume all who taper drugs have to go through the cycle of hitting different receptors on the way down....whether they CT, Fast Taper or do a Slow Taper.  It is just less noticeable when done 'properly."  I also imagine those that CT and then have continued issues in one area or another (that sometimes are relieved when a small dose is reinstated) is because the drug is needed to down regulate the receptors 'in a pattern.' If the drug is removed completely, the brain can get stuck or confused in how to repair itself without the offending drug on board that was controlling receptor activity.  I have no idea obviously and am but an ignorant lay person......but it makes sense in my brain. :)

 

Again, thanks so much for taking the time to respond and for your valuable insight.  Warm Regards, Glosmom

 


2016 - Oct -Daughter started Risperdal (for steroid induced psychosis that never went away after stopping prednisone)

Nov - dose increases stopped at 1.5mg in Dec

2017 - Jan- weaned from 1.5 to 1.0 in 2 weeks then 1.0 to .5 in two weeks and then off. Feb. 3 weeks of increased psychosis, pacing, insomnia, other awful symptoms so late Feb  - Back on 1.5 mg Risperdal. May  - decrease to 1.25mg, two weeks later 1.0mg - symptoms started again. June - held steady at 1.25mg for 6 weeks and switched to liquid (3 ml syringe). July - started 10% taper every 3 weeks, October -  .8 mg, December - .7 mg .

2018 -Jan- 0.65 mg,  Feb- 0.59,  Mar-0.50, late April - .40mg, July- .36 mg, Aug - switched from 3 mL syringe to 1 mL syringe for more accuracy (her dad and i were not sure we were giving her the same dose when in between the 'dashes' on the 3 mL syringe.) Aug -.30 mg (3mL syr)/.44 mg (1 mL syr) difference due to med in the tip of both syringes). Sept- .28 mg (3mL syr)/.42 mg (1 mL syr). Oct - .16 mg (3 mL syr)/.30 mg (1 mL syr). Nov.- .06mg (3mL syr)/.20 mg (1mLsyr). Dec. - tip only/unmeasurable (3mL syr)/.10 mg (1mLsyr)

2019- Jan -.06 mg (1 mL syr), Feb- .025 mg (1 mL syr), Feb 27, 2019 - jumped to zero!!

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Altostrata

A tapering database is a brilliant idea. Who has the expertise and time to put this together?


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Onmyway
On 8/14/2020 at 5:37 PM, Altostrata said:

A tapering database is a brilliant idea. Who has the expertise and time to put this together?

My GP sends out a survey every week relating to Covid where every person puts their symptoms - i.e. do you have loss of sense of smell, do you have new cough etc. this past week. Something like that would be simple to do here. Survey answers through various free or cheap software can then automatically go into a database. Happy to help with something like this if needed.

 

For example, something like this: https://www.surveymonkey.co.uk/r/VMR6ZY3

 

OMW. 


Aug  2000 - July 2003 (ct, 4-6 wk wd) , citalopram 20 mg ,  xanax prn, wellbutrin for a few months (don't remember dates), trazodone prn 

Dec 2004 - July 2018 citalopram 20 mg

Aug 2018 - citalopram 40 mg (self titrated up), occasionally did this in difficult times 

September 2018 - January 2019 tapered citalopram - 40/30/20/10/5 no issues until a week after reaching 0

Feb 2019 0.25 xanax/day, then 0.5/day (3 weeks) over to klonopin 0.25 once a day to manage severe wd

March 6, reinstated citalopram 2.5 mg (liquid), klonopin 0.25 mg for sleep 2-3 times a week

Apr 1st 2.0 mg (liquid), klonopin 0.25 once a week, April  14 , 2019 - citalopram 1.8 mg (liquid), May 8, 2019 - citalopram 1.6 mg (liquid),  July 27, 2019 - citalopram 1.5 mg (liquid),  August 15, 2019 - citalopram 1.35 (liquid)

 

 supplements:  melatonin 1 mg  

 

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Altostrata

Please contact me if you'd like to head up this project.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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