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Aligning tapering to menstrual cycle


bunchesofoats
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I'm curious if others of the menstrual persuasion have aligned their tapering drop dose dates with certain days in their cycles and if anyone knows a good deal about the interactions between the hormones and medication/tapering.

 

The first time I tried to taper down from 30mg citalopram, it just happened to be during my most difficult week of the cycle (PMS week aka within 7 days before my period starting), and that was horrendous. The second time I smartened up and decided to do it during my "good" week or around day 7 of my cycle, though with the surge of estrogen during that period it can also be difficult. I know there of course isn't a *perfect* (that word should be censored out like a curse word), but I'm wondering if, in general, to those who this is relevant, there is a time during the month when dropping dosage is less harsh on the body.

2005-2009 18mg concerta on and off

2009-2013 ritalin and buproprion on and off; 2010 nortryptyline, amitriptyline for accident pain; 2014 Apr - lamictal 2 weeks until hives

2016 Mar...Sep -  st. john's wort, rhodiola, other supplements tried

2016 Nov...2017 Mar - began & increased citalopram (4 months) up to 30mg (11months)

2018 Feb - began taper, ~2.5mg/month, cutting tablets (3 months)

2018 May - 20mg, tried ~17.5mg but symptoms too strong, held at 20 (11 months)

2018 Nov - tried bupropion again, stopped within a couple months

2019 Apr - began ~5%/month taper from 20mg using dissolve in water and measure with syringe method

2020 Jan - no lorazepam for 1year; 0.5mg lorazepam average 3x/month since began citalopram; at most 3x/week

2021 June - 10mg. Race like the tortoise.

 

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  • 2 weeks later...

Hi,

This makes a lot of sense to me.

I use a free app called "Clue" to track my period and symptoms. I might check the symptom pattern, and make sure to drop at a "better" time of the month. 

Thanks for the post!

2005-2018: Sertraline 50mg

Jan 2018: Started taper from 50mg

Jun 2018: 25 mg

July 2019: 20 mg. Switched to Microtapering

Spring 2020: Tetanus vaccine and a course of rabies vaccinations. 

July 2020: 16 mg. Hold.

During 2020, I was forced to change manufacturers(of generic Sertraline) 4 times due to supplier issues. I didn't write the dates down. 

1st Oct&4th Oct 2020: IV drip with Metoclopramide, ranitidine, hyoscine butylbromide in hospital

26 October 2020: 17 mg

1Nov: 16mg

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  • 2 months later...

Hey! I'm planning to do this. My last year of drug cocktails has been during a postpartum period, too (and because of), so I'm all sorts of hormonally sensitive and discombobulated right now. I notice that I have a much easier time with reducing or adding anything about 50-75% of the way through my cycle (week 3-4). So that's when I'm planning on doing reductions or additions (of supplements) if I can (and if my cycle remains regular - that's the kicker).

 

I'm also trying to find supplements that might help regulate my cycle (bioidentical progesterone cream RXed from a doc helped somewhat with mood, but caused other havoc - cramping, spotting, acne - so I'm going to avoid that in the future if I can). Will see what I find.

Full Story: https://www.survivingantidepressants.org/topic/21026-northstar-postpartum-year-hell-~20-meds-on-and-off-brain-feels-like-a-limp-rag/
1999ish-2005 (age 12-18): Zoloft, Lexapro, Wellbutrin (unsure of doseages)
2009-2017: Prozac (40mg) and Xanax PRN (took maybe 10x/yr); went off with no issues when pregnant
After birth of son in May 2018: waded through a difficult year of 20+ med trials of various combinations (while taking 1,000-2000 vitamin D/day, multivitamin, fish oil, 400-800 mcg folic acid, probiotics, and sometimes evening primrose oil throughout much of this time):

  • July 2018: 6mg Zoloft once (bad reaction)
  • July - Sept 2018: 0.5 - 1mg Ativan/day PRN (rarely took, went off); moved to just 25mg/night trazodone for sleep; went off after a few nights when I could sleep on own
  • Sept 2018: 1-7mg Prozac (bad reaction; couldn't make it passed 7mg) w/ 0.5 - 1mg Ativan/day PRN
  • Oct - Nov 2018: 0.25 - 0.75mg Klonopin/day
  • Nov 2018: 3-day Anafranil trial (25 mg); reaction --> hospital
  • Late-Nov - Early-Dec 2018: 100mg Seroquel + 0.5mg Klonopin 2x/day (eventually reduced to 0.25mg 2x/day)
  • Early-Dec 2018 - Early-Jan 2019: Worked up to 100mg Lamictal/day + 2.5mg Zyprexa/day + 0.5-1.5 mg Ativan/day
  • Early-Jan 2019: Bad reaction to above meds --> hospital for a week
  • Early-to-mid - Jan 2019: 5mg Paxil + 0.5mg Klonopin 2x/day + 0.25-1mg risperidone 1-2x/day + 50mg Benadryl (sleep)/night; bad reaction to risperidone after 1 week so taken off
  • Late-Jan 2019: 5mg Paxil + 0.5mg Klonopin 2x/day + 100-150mg Seroquel/night; mood worsened, back in hospital...
  • Late-Jan - Mid-Feb 2019 (hospital):
    • First week: 0.5 mg Klonopin 2x/day, 100 mg Seroquel at night, 300mg XR lithium 2x/day
    • Second week: 0.5 mg Klonopin 2x/day, 50mg Seroquel at night, some amount of Depakote, tried PRNs of 12.5mg Seroquel
    • Third week: 1 mg Klonopin 2x/day, 50mg Seroquel at night, 1200mg gabapentin (taken as 300mg twice during the day, and 600mg at night).
  • Mid-Feb - Early-March 2019: 0.75mg Klonopin 2x/day, 50mg Seroquel at night, 300mg Gabapentin 2x daytime and 600mg at night, brief re-trial of lithium – 150mg
  • Mid-March 2019: →0.25mg Klonopin during day + 0.5-0.75mg/night, 25mg Seroquel/night, 200mg Gabapentin 2x daytime + 300mg/night, brief re-trial of Depakote (don’t remember dosage)
  • Early-April 2019: Hyperthyroidism from thyroiditis (docs suspect lithium) diagnosis; added propranolol (20- 70mg/day)
  • April 2019 - June 2019:
    • Tapered from 25 to 0mg Seroquel
    • Tapered ABRUPTLY to 0mg Propranolol (due to hyperthyroid resolution and LOW BP)
    • Tapered ABRUPTLY from 400 to 0-200 gabapentin during day; take 300mg/night
    • 0.5mg Klonopin/night
  • July 2019 Day: 0.1mg Klonopin day; Night: 0.4mg Klonopin + 270mg gabapentin night + 5mg SR melatonin (+10mg B6)/night + 350mg magnesium
  • Sept 2019: Day: 0.1mg Klonopin day; Night: 0.4mg Klonopin + 250mg gabapentin night + 3mg melatonin/night + 350mg magnesium + 500mg quercetin 2x/day + 500-1,000mg vitamin C/day + 700-1050mg PEA/day + black nigella seed oil as needed (latter 4 for MCAS)
  • June 2020: 0.1 mg Klonopin day; 0.355 mg Klonopin night (tapered from March > June 0.384 > 0.37 > 0.355); 130mg Gabapentin night (tapered Fall-Winter 2019/2020 at 10% previous dose); 5-10 mg propranolol PRN for POTS; 5-15mL Children's Benadryl for MCAS PRN; 1.5 mg melatonin/night + 125 mg magnesium glycinate day + 350mg magnesium composite supp night + 500mg quercetin 2x/day + 1,000-2,000 mg vitamin C/day + 700mg PEA/day + 15mg zinc/day + Vitamin B6 at night PRN (helps w/ restlessness) + occasional 1/2 dose of multivitamin
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  • 3 weeks later...

This is a super interesting topic.

I am perimenopausal AND have a Mirena coil AND a giant uterine fibroid tumour, so I don't have any bleeds, but I think that my hormones are probably still fluctuating, maybe not in a regular fashion. I think I will research how to monitor my endogenous female hormone levels myself to help me with tapering withdrawal.

 

Thanks for this.

 

Bridgetini. xx

January 2021: Cut Venlafaxine XR by 9% to 125mg; holding Lorazepam at 1.25 mg.

October 2020: Reduced Venlafaxine XR to 137.5 mg while keeping Lorazepam at 1.25 mg.

August 2020:  Made a 16% reduction in Lorazepam at psychiatrist's recommendation (1.25 mg) while holding Venlafaxine at 150 mg.

March 2019 - March 2020: Venlafaxine  XR tapered from  337.5 mg  to 150 mg (60% reduction), while continuing 1.5 mg Lorazepam.

March 2016 - January 2019: Mirtazapine taptered to 0, while continuing on 1.5 mg Lorazepam and 375 mg Venlafaxine XR.

Feb. 2015: 7.5 mg Mirtazapine + 1.5 mg Lorazepam + 375 mg Venlafaxine.

 

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  • 3 weeks later...

I was using the app ovia for years to track my cycle and symptoms, but it didn't tell me anything super useful with the data. I got fed up and made my own table in google docs which I printed out and wrote on every day. I printed out new ones every months for a few months and noticed some interested patterns. For example, the night after my 5th day, I always have crazy weird dreams (probably an increase in estrogen leading to an increase in melatonin, but I'm really kind of talking out of my butt here). I'm also at my most vulnerable around day 21/22/23. For me it was far more insightful to create my own table and physically write my symptoms down every day. Now I've been dropping my dosage during the first week (for whatever reason, it's the easiest for me), and that has helped tremendously.

2005-2009 18mg concerta on and off

2009-2013 ritalin and buproprion on and off; 2010 nortryptyline, amitriptyline for accident pain; 2014 Apr - lamictal 2 weeks until hives

2016 Mar...Sep -  st. john's wort, rhodiola, other supplements tried

2016 Nov...2017 Mar - began & increased citalopram (4 months) up to 30mg (11months)

2018 Feb - began taper, ~2.5mg/month, cutting tablets (3 months)

2018 May - 20mg, tried ~17.5mg but symptoms too strong, held at 20 (11 months)

2018 Nov - tried bupropion again, stopped within a couple months

2019 Apr - began ~5%/month taper from 20mg using dissolve in water and measure with syringe method

2020 Jan - no lorazepam for 1year; 0.5mg lorazepam average 3x/month since began citalopram; at most 3x/week

2021 June - 10mg. Race like the tortoise.

 

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  • 4 months later...

https://www.fairview.org/patient-education/85704

 

According to the article above serotonin is lowest during the last 2 weeks of the menstrual cycle, before your period.  I would think that it would make most sense to taper when serotonin is highest.  This would be the first part of the cycle.  I normally start to feel more down the week before my period.  Then on my period I am more tired.  So I don’t think either of those weeks would be the best time to taper.  Maybe right after the period ends. 

1993-2000: Zoloft few months CT, Prozac 1-2 yrs, Ritalin PRN

2002/2003: Wellbutrin,  Paxil 25mg FT, and Xanax PRN CT (all 3 to 6 months), Adderal 40mg, Strattera 40mg

2003- 2016: Effexor XR 75 mg to 150 mg., Strattera (2002-2008)

2017: Effexor XR 225 mg. Gabapentin 300 mg. Elavil 25 mg.

2018: (Sept.) Effexor XR 187.5 mg, Zoloft 10 mg. (OCT.) FT off Gabapentin (NOV.) FT off Elavil (DEC) FT Effexor to 150 mg.

2019: (JAN.) D/C Zoloft, added Viibryd 10mg (FEB) CT Viibryd, (MAR) Prozac bridge, Effexor xr 112.5mg, (Sept.) Effexor XR 112.5 mg + 0.4 mg (1 bead), (Oct.) Effexor XR 112.5mg, (Dec.28) start 10% taper Effexor XR 101.25 mg, 

2020: (Jan. 25) Effexor XR 91 mg., (Feb. 22) Effexor xr 82 mg., (Mar. 21) 75 mg. 

Supplements:  Vitamin D 5000 IU topical, Probiotic 6 billion CFU, Epsom salt bath 1C 2 to 3 X week, California Poppy 2 droppers, various essential oils 

https://www.survivingantidepressants.org/topic/21446-superwoman-effexor-taper/page/8/?tab=comments#comment-475779

 

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3 hours ago, Superwoman said:

https://www.fairview.org/patient-education/85704

 

Selon l'article ci-dessus, la sérotonine est la plus faible au cours des 2 dernières semaines du cycle menstruel, avant vos règles. Je pense qu'il serait plus logique de diminuer progressivement lorsque la sérotonine est la plus élevée. Ce serait la première partie du cycle. Je commence normalement à me sentir plus déprimé la semaine avant mes règles. Ensuite, sur mes règles, je suis plus fatigué. Je ne pense donc pas que l'une de ces semaines soit le meilleur moment pour diminuer. Peut-être juste après la fin de la période. 

hello
Thank you for the article, it confirms the amplified symptoms I have during menstruation and before.  

Deroxat (paxil) 20 mg pour 10 ml

12/14 18 mg réduction de 5% tous les mois 13/01/15 14.4mg 15/08 9,6 mg 16.01 reduction3% 8 mg par mois 16/02 7,8 mg 18.02 3 mg

18.03 2,92 à 3% 5 mai 2018 2,74 mg 3% 5 mai 2018 2,74 mg 3% 5 mai 2018 2,74 mg 3% 5 mai 2018 2,74 mg

 18/06 2,66 mg

26/06/18 2,58 mg en 26 jours

19/03 1,78 mg 15 jours

19/04 1, 64 mg 21 jours

19/05 1,58 mg

24/07/19 1,44 mg

14/08/19 1,4 mg

27/09/19 1,48 mg

10/09/19 retour à 1,58 mg  27/12/19 retour à 1,65mg direct transition to fluoxetine the 11/01/2020 1,65mg

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Your welcome @rola.

1993-2000: Zoloft few months CT, Prozac 1-2 yrs, Ritalin PRN

2002/2003: Wellbutrin,  Paxil 25mg FT, and Xanax PRN CT (all 3 to 6 months), Adderal 40mg, Strattera 40mg

2003- 2016: Effexor XR 75 mg to 150 mg., Strattera (2002-2008)

2017: Effexor XR 225 mg. Gabapentin 300 mg. Elavil 25 mg.

2018: (Sept.) Effexor XR 187.5 mg, Zoloft 10 mg. (OCT.) FT off Gabapentin (NOV.) FT off Elavil (DEC) FT Effexor to 150 mg.

2019: (JAN.) D/C Zoloft, added Viibryd 10mg (FEB) CT Viibryd, (MAR) Prozac bridge, Effexor xr 112.5mg, (Sept.) Effexor XR 112.5 mg + 0.4 mg (1 bead), (Oct.) Effexor XR 112.5mg, (Dec.28) start 10% taper Effexor XR 101.25 mg, 

2020: (Jan. 25) Effexor XR 91 mg., (Feb. 22) Effexor xr 82 mg., (Mar. 21) 75 mg. 

Supplements:  Vitamin D 5000 IU topical, Probiotic 6 billion CFU, Epsom salt bath 1C 2 to 3 X week, California Poppy 2 droppers, various essential oils 

https://www.survivingantidepressants.org/topic/21446-superwoman-effexor-taper/page/8/?tab=comments#comment-475779

 

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There's also the progesterone and GABA system to consider. Progesterone is highest in the last two weeks of the cycle, between ovulation and menstruation. (Minus the last couple days before menstruation.) The drop in progesterone is what triggers menstruation, and many common "PMS" symptoms are essentially from progesterone withdrawal. Progesterone has a metabolite that functions in the brain similar to a benzo, by activating the GABA receptors.

 

For most people, the high progesterone part of the cycle is mood-wise pretty good, because progesterone is calming, helps with sleep, all that good stuff. But there are some women who have a "paradoxical reaction"  to progesterone and it causes increased anxiety, anger, and other similar negative moods. Some doctors now think that's the cause of PMDD (bad mood for two weeks before menstruation, rather than the normal progesterone withdrawal bad mood for the couple days before menstruation). If you feel good most of the two weeks before menstruation, you're reacting "normally" to progesterone and it's not PMDD, it's PMS. If you feel like crap for those two weeks and your mood actually improves a day or two before your period (when you stop producing progesterone), you're having a paradoxical reaction to progesterone.

 

The weird thing with progesterone is that in these sensitive people, it seems like a small amount of progesterone is alerting, but a larger amount is calming. I guess it's similar to a lot of psychiatric medications in that way, something that's normally calming in larger quantities is activating at smaller quantities. The suggested way to deal with PMDD so far is taking SSRIs, which actually slow down the breakdown of the progesterone metabolite so it can build up to hit that threshold where it's calming, or supplementing bioidentical progesterone.

 

I personally think that it's a massive oversight with drug prescribing that the natural hormonal cycles that affect neurochemicals are more or less ignored.

2018/7 Started on lamotrigine (12.5 mg) and escitalopram (2.5 mg). Tapered up over the course of a month to 50 mg LTG, 10 mg escit. Kept tapering LTG up to 75 mg by 2018/10. 2018/11 Crosstapered from escitalopram to sertraline. 2018/12 Was still taking both SSRIs (escit. 5 mg, sert. 25 mg) when sert. was discontinued to trial quetiapine. Quet. tapered up to 25 mg, but tapered back down after 3 days on the full dose because side effects. Total time on quetiapine 10 days. Switched back to cross tapering esit. and sert., started tapering LTG up to 100 mg.
 
2019/1 Lamotrigine 100 mg, sertraline 12.5 mg, escitalopram 5 mg. Finally discontinued escit. and on full dosage of sertraline (25 mg) 2019/04.
 
2019/11 About two weeks of sertraline 12.5 mg, but went back up to 25 mg.
2019/12/4 Lamotrigine taper: too fast, down to 25 mg over the course of about 10 days. Also started increase sertraline 37.5 mg during luteal phase of menstrual cycle for PMDD.
 
2020/(early) on 22 mg lamotrigine for a while, maybe a month and a half, maybe longer, then 2020/03 Institutionalized for self harm. I think I was trying to taper the sertraline at the time, don't remember the details. Doses increased: Sertraline 50 mg/lamotrigine 25 mg (current regimen). Supposed to be taking seroquel and abilify (TWO antipsychotics?!) but didn't take any once I was discharged from the institution. (Was on them a few days.)
________________________________________________________
2001(?) Citalopram, don't remember dosage, cold turkey after a couple months and had terrible withdrawals, including what in retrospect was probably PAWS for the next five or so years. (agoraphobia, crippling social anxiety, anhedonia, dp/dr).
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Interpretations based on "serotonin imbalance" and its variations aside, which can have no validity since the "serotonin imbalance" theory is poppycock, we have many members who say their withdrawal symptoms ramp up at points in their menstrual cycle, usually pre-menstrual or while they are menstruating.

 

If this happens to you, it seems common sense not to reduce your drug dosage just prior to menstruation or whenever in your cycle you might be most vulnerable.

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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  • 2 weeks later...

So glad I found this topic! I was just about to ask a similar question: do withdrawal symptoms ramp up during menstruation?

The above partly answers it. What is super strange for me is that this is the first month off my oral contraceptive. On my contraceptive, my period was a non-event, i.e. no mood changes, no sleep changes, no pain/cramps. In this first month off, in the two days leading up to my period, I have struggled to sleep, and have had pain/cramps. It is actually really interesting that a synthetic hormone (progestin) could cause such a difference.

For those of you who have stopped their oral contraceptive, how long has it taken to stabilise (i.e. become symptom free in the days leading up to the period)? Or is this "bad few days" permanent in the absence of the contraceptive?

Bee

7 months of polypharmacy in 2015-2016, including several classes of psych meds.

1st attempt at taper was too fast. 2nd attempt is underway.

1 Mar 2018: 37.5 mg paroxetine, 150 mg lamotrigine, 300 mg quetiapine

1 Oct 2020: 30 mg paroxetine, 150 mg lamotrigine, 37.5 mg quetiapine

1 Mar 2021: 30 mg paroxetine, 150 mg lamotrigine, 12.5 mg quetiapine 

Aug 2021: 30 mg paroxetine, 150 mg lamotrigine, 3.9 mg quetiapine.

Supplements: Iron, probiotics, omega 3, magnesium glycinate.

I am not a medical professional. All my posts are my opinions only, based on my experiences.

 

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  • 1 month later...
On 1/7/2020 at 2:37 AM, Bee5 said:

So glad I found this topic! I was just about to ask a similar question: do withdrawal symptoms ramp up during menstruation?

The above partly answers it. What is super strange for me is that this is the first month off my oral contraceptive. On my contraceptive, my period was a non-event, i.e. no mood changes, no sleep changes, no pain/cramps. In this first month off, in the two days leading up to my period, I have struggled to sleep, and have had pain/cramps. It is actually really interesting that a synthetic hormone (progestin) could cause such a difference.

For those of you who have stopped their oral contraceptive, how long has it taken to stabilise (i.e. become symptom free in the days leading up to the period)? Or is this "bad few days" permanent in the absence of the contraceptive?

Bee

From what I have read, when you first come off the pill you may experience increased PMS until your hormones regulate. For most people that is 3-6 months. After that you should go back to whatever you were like pre pill. The problem though is that quite a few of us in withdrawal have a massive uptick in symptoms before or during our periods, so much so that you could classify it as PMDD (pre menstrual dysphoric disorder). I came off the pill at the same time I came off my antidepressant. My hormone tests show that all is well, but during my period my withdrawal symptoms ramp up so much that I just lose it.. pretty much ! So if you're in withdrawal too you may find it hard to tell what is your hormones adjusting and what is your body reacting negatively to hormonal fluctuations due to withdrawal. When hormones drop, serotonin drops.. and that's a disaster for a lot of us i'm sure.

2009-2018: 15mg Celexa

 

June 2018-January 2019: .5mg-1mg Ativan

 

2010-June 2021: Marvelon (Birth Control) 

 

September 2018-Present: Prozac reinstated 1mg (.25ml) April 21st 2019 , updosed to .32ml June 19, 2019 & started taper in October 2019.

 

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Thanks for the interesting notes @bottlehalffull on the possible expected and paradoxical effects of progesterone. My absolute worst day is always day 21 (with 22 and 23 being front runners). This would seem to be at peak progesterone so perhaps it's a form of withdrawal just as the peak progesterone begins to drop. During these days I can identify a flare up of ADWD symptoms since I'm much more aware of them now. I agree wholeheartedly with this sentiment:

On 12/23/2019 at 11:41 AM, bottlehalffull said:

I personally think that it's a massive oversight with drug prescribing that the natural hormonal cycles that affect neurochemicals are more or less ignored.

 

Thanks everyone for your interesting input thus far!

2005-2009 18mg concerta on and off

2009-2013 ritalin and buproprion on and off; 2010 nortryptyline, amitriptyline for accident pain; 2014 Apr - lamictal 2 weeks until hives

2016 Mar...Sep -  st. john's wort, rhodiola, other supplements tried

2016 Nov...2017 Mar - began & increased citalopram (4 months) up to 30mg (11months)

2018 Feb - began taper, ~2.5mg/month, cutting tablets (3 months)

2018 May - 20mg, tried ~17.5mg but symptoms too strong, held at 20 (11 months)

2018 Nov - tried bupropion again, stopped within a couple months

2019 Apr - began ~5%/month taper from 20mg using dissolve in water and measure with syringe method

2020 Jan - no lorazepam for 1year; 0.5mg lorazepam average 3x/month since began citalopram; at most 3x/week

2021 June - 10mg. Race like the tortoise.

 

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  • 3 weeks later...

Thanks @Eastcoastgirl, I guess I have a few months to go then until the hormones stabilise.

Edited by Karma
Name update

7 months of polypharmacy in 2015-2016, including several classes of psych meds.

1st attempt at taper was too fast. 2nd attempt is underway.

1 Mar 2018: 37.5 mg paroxetine, 150 mg lamotrigine, 300 mg quetiapine

1 Oct 2020: 30 mg paroxetine, 150 mg lamotrigine, 37.5 mg quetiapine

1 Mar 2021: 30 mg paroxetine, 150 mg lamotrigine, 12.5 mg quetiapine 

Aug 2021: 30 mg paroxetine, 150 mg lamotrigine, 3.9 mg quetiapine.

Supplements: Iron, probiotics, omega 3, magnesium glycinate.

I am not a medical professional. All my posts are my opinions only, based on my experiences.

 

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