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Zans: tapering off 10mg Brintellix - 4 years?

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Zans
On Thursday, September 12, 2019 at 1:13 AM, ChessieCat said:

 

I think it's time to have a nice long hold, at least 2 months, 3 would be better.  You have made many changes in the last 4 months, see ^ quote.  Give your brain the time it needs and get nice and stable.  If you keep reducing you might make things much worse.  Withdrawal can be delayed and/or the dose changes can catch up with you.  When this happens it is sometimes hard to stabilise and/or can take a long time, and some members never stabilise and have to taper anyway.

 

 

No, this is not the way to taper.  Jumping up and down, aka yo-yoing, your doses can backfire on you.  And we have members here who have done this and it has ended up taking longer to get off their drug than if they done a nice steady taper.

 

Many members find that as their dose gets lower they need to go slower, reducing less and/or holding longer  Why taper paper: dose-occupancy curves

 

And you don't have to reduce by 10%.  You can always reduce by a smaller amount.  The rate you taper at should be what you can reduce by that doesn't cause bad withdrawal symptoms.

 

The harm reduction method of tapering means that we take away a little bit of the drug and then stay on that dose to allow the brain to adapt to not getting as much of the drug.  Then we can take away a little bit more and so on.

Thanks. It's obviously discouraging to stay 3 months on same dose but if you say it's for better - safer journey then I have to nod on that. I suffered and still suffering good amount. No need for more.

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ChessieCat
1 hour ago, Zans said:

It's obviously discouraging to stay 3 months on same dose

 

Yes it seems that way, but it is better in the long run.  I was fortunate to be able to reduce from 100mg Pristiq to 75mg but I only held on that dose for 2 months.  I was suffering from mild serotonin toxicity so I wanted to get my dose lower.  I tapered by 10% (with a couple of tiny updoses to start) until I got to 50mg and then held on that for 3 months to allow my brain a chance to catch up if it needed it.  Pristiq is only available (in Australia) in 50mg and 100mg tablets (I have to get my doses compounded, out of pocket).  Then I resumed tapering and even though everything was going okay when I got to 20mg I had plenty of capsules so I held for about 7 weeks.

 

Both times that I chose to hold longer I was not doing it because of withdrawal symptoms.

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Zans
38 minutes ago, ChessieCat said:

 

Yes it seems that way, but it is better in the long run.  I was fortunate to be able to reduce from 100mg Pristiq to 75mg but I only held on that dose for 2 months.  I was suffering from mild serotonin toxicity so I wanted to get my dose lower.  I tapered by 10% (with a couple of tiny updoses to start) until I got to 50mg and then held on that for 3 months to allow my brain a chance to catch up if it needed it.  Pristiq is only available (in Australia) in 50mg and 100mg tablets (I have to get my doses compounded, out of pocket).  Then I resumed tapering and even though everything was going okay when I got to 20mg I had plenty of capsules so I held for about 7 weeks.

 

Both times that I chose to hold longer I was not doing it because of withdrawal symptoms.

Quite a long journey to go from 100mg down to 2.25mg! 

 

Were you able to work during your tapers? That's probably one of the most crushing aspects of this whole process. Being limited in life areas such as job.

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ChessieCat

I've been unable to find paid employment (other than the odd 1 day temp role) after losing my job mid-2011.  But I have managed to build up to volunteering 3 days a week, which I've been doing for about 6 years.

 

I'm about to turn 62.

 

Edited by ChessieCat

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Zans
3 minutes ago, ChessieCat said:

I've been unable to find paid employment (other than the odd 1 day temp role) after losing my job mid-2011.  But I have managed to build up to volunteering 3 days a week, which I've been doing for about 6 years.

 

I'm about to turn 62.

 

Ah, sorry to hear about job loss. Hopefully volunteering provides enough fullfilment and distraction for you. Plus doing good adds karma points 😀

 

I am 31 but I feel way older because all of this. I hope life is still ahead of me and I'll be able to recover.

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Zans

It feels like I triggered WD. Having sleep problems again, constipation out of nowhere, deep depression returned, no ability to relax. Life quality went from 7 to 3. Not much can be done now? Just wait and crossfingers it pass sonner then later?

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ChessieCat

Sleep problems - that awful withdrawal insomnia

 

We strongly encourage members to learn and use non drug coping techniques to help get through tough times.

 

Understanding what is happening helps us to not get caught up with the second fear, or fear of the fear.  This happens when we experience sensations in our body and because we don't understand them we are scared of them and then start to panic.

 

This document has a diagram of the body explaining what happens in the body when we become anxious:

 

https://www.getselfhelp.co.uk/docs/AnxietySelfHelp.pdf

 

 

Audio FEMALE VOICE:  First Aid for Panic (4 minutes)

 

Audio MALE VOICE:  First Aid for Panic (4 minutes)

 

Non-drug techniques to cope

 

dealing-with-emotional-spirals

 

Dr Claire Weekes suffered from anxiety and learned and taught ways of coping.  There are videos available on YouTube.

 

Claire Weekes' Method of Recovering from a Sensitized Nervous System

 

Audio:  How to Recover from Anxiety - Dr Claire Weekes

 

 
Resources:  Centre for Clinical Interventions (PDF modules that you can work through, eg:  Depression, Distress Intolerance, Health Anxiety, Low Self-Esteem, Panic Attacks, Perfectionism, Procrastination, Social Anxiety, Worrying)
 
On 4/28/2017 at 4:03 AM, brassmonkey said:

 

AAF: Acknowledge, Accept, Float.  It's what you have to do when nothing else works, and can be a very powerful tool in coping with anxiety.  The neuroemotional anxiety many of us feel during WD is directly caused by the drugs and their chemical reactions in the brain.  Making it so there is nothing we can do about them.  They won't respond to other drugs, relaxation techniques and the like.  They do, however, react very well to being ignored.  That's the concept behind AAF.  Acknowledge, get to know the feeling involved, explore them.  Accept, These feelings are a part of you and they aren't going anywhere fast. Float, let the feeling float off as you get on with your life as best as you can.  It's a well documented fact that the more you feed in to anxiety the worse it gets.  What starts as generalized neuroemotinal anxiety can be easily blown into a full fledged panic attack just by thinking about it.

 

I often liken it to an unwanted house guest.  At first you talk to them, have conversations, communicate with them.  After a while you figure out that they aren't leaving and there is nothing you can do to get rid of them.  So you go on about your day, working around them until they get bored and leave.

 

It can take some practice, but AAF really does work.  I hope you give it a try.

 

 

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Zans

Thanks for links.

 

Further additional reinstatement is not neccessary and better is to wait it out?

 

Edited by ChessieCat
removed quote

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ChessieCat

This issues you are currently experiencing might not be related to the Brintellix reduction.  You've cold turkeyed various drugs since December 2018(?) - your drug signature says 2019.  Please amend.

 

Even if the above was supposed to be December 2017, you have cold turkeyed other various drugs in both March and May this year.

 

And you made a 50% reduction in June 2019 as well.  Because of all the changes it makes it impossible to know what is causing the current issues.

 

And it's only been 1 week (I think) since you updosed from 4.5mg to 4.6mg.

 

Considering all the changes you have made it would seem that you are doing reasonably okay.  I realise it's not as good as you would like, but try to see it from your brain's point of view.  I think it's time to just tough it out and give your brain a chance.

 

And I will reiterate, a nice long hold ... now that your sleep is being affected I don't think you should be even considering making another reduction for at least 3 months and it may even end up being 4-6 months, so be prepared to be patient.

 

Please note that I am not suggesting that you updose.  However if you do decide to updose my suggestion would be to only increase by a tiny amount, 0.25mg or 0.5mg.  Definitely not up to 4.7mg.

 

Remember that if you do updose it's another change that your brain will be trying to adapt to and it might not make any difference because of what I mentioned before about all the CTs.

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Zans
On Sunday, September 15, 2019 at 9:04 AM, ChessieCat said:

This issues you are currently experiencing might not be related to the Brintellix reduction.  You've cold turkeyed various drugs since December 2018(?) - your drug signature says 2019.  Please amend.

 

Even if the above was supposed to be December 2017, you have cold turkeyed other various drugs in both March and May this year.

 

And you made a 50% reduction in June 2019 as well.  Because of all the changes it makes it impossible to know what is causing the current issues.

 

And it's only been 1 week (I think) since you updosed from 4.5mg to 4.6mg.

 

Considering all the changes you have made it would seem that you are doing reasonably okay.  I realise it's not as good as you would like, but try to see it from your brain's point of view.  I think it's time to just tough it out and give your brain a chance.

 

And I will reiterate, a nice long hold ... now that your sleep is being affected I don't think you should be even considering making another reduction for at least 3 months and it may even end up being 4-6 months, so be prepared to be patient.

 

Please note that I am not suggesting that you updose.  However if you do decide to updose my suggestion would be to only increase by a tiny amount, 0.25mg or 0.5mg.  Definitely not up to 4.7mg.

 

Remember that if you do updose it's another change that your brain will be trying to adapt to and it might not make any difference because of what I mentioned before about all the CTs.

Hey,

 

doing really bad lately. Didn't sleep at all for two days straight. During the daytime I feel so weared down but I can't relax. Can't yawn or sigh. Seems as if my nerves is on alert mode 24/7 now. Some inner discomfort that keeps me feeling restless all the time.

 

I know you mentioned toughing it out and I guess I will have too but do you know whether this looks like wave or full on withdrawal?

 

Thank you

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Zans

So things going really difficult further. My mom thinks I could of messed myself by switching to liquid - syringe method. Her opinion is that most of the pill might just stay at the bottom and I only inject water. Though I do shake it good jar I am thinking if she has a point. 

 

Whole August I was injecting 5ml with syringe and experience was bearable. From September first it slowly went downhill and now I do feel really desperate.

 

Worst symptom is 24/7 stress. I can't relax at all and being still is getting to be impossible. Insomnia is also not "peacefull" where I just lie and stare at the ceiling. I am experiencing strong inner restlesness that makes me toss around all night. Can't complete yawning and sighing. If that is going to continue for couple more days I probably will jump back to 5ml and hopefully stabilize. Afterwards would hold for long period of time.

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eymen23
1 hour ago, Zans said:

So things going really difficult further. My mom thinks I could of messed myself by switching to liquid - syringe method. Her opinion is that most of the pill might just stay at the bottom and I only inject water. Though I do shake it good jar I am thinking if she has a point. 

 

Whole August I was injecting 5ml with syringe and experience was bearable

 

Hi Zans,

 

I’m very sorry to hear that you are struggling so much. The near-constant discomfort that you describe can be very hard for people to bear, as it doesn’t allow for much respite or feeling of having a ‘break’ to recuperate and know things will get easier. Please try to remain hopeful and use methods of distraction or self-soothing as much as possible. 

 

Reading through your thread and looking at your signature, it seems your nervous system has become destabilised over time with numerous drugs and changes. Very often we see that the effects of these changes accumulate over time, and eventually it reaches a stage where symptoms seem to persist irrespective of the particular drug or dosage currently taken. 

 

I would suggest a long hold until things start to settle down. Although you might not reach a point of being totally symptom free, you will likely reach a point where symptoms are consistent and tolerable. This is known here as ‘withdrawal normal’. From there you could consider resuming your taper at a gentle pace. 

 

In regards to your mum’s point about most of the tablet staying at the bottom of the liquid, assuming you’re still taking Brintellix, the active ingredient (vortioxetine hydrobromide) is ‘slightly soluble’ in water. From a more practical perspective, this means that 5mg of the drug will dissolve in 5ml or water. So as long as you use at least 5ml or water and remember to stir well, the only part of the tablet staying at the bottom of the liquid should be the inactive ingredients such as fillers. 

 

To me it seems more likely that the change to liquid itself upset your system, in combination with all the changes you previously made and that Chessie outlined. Again, a long hold of your current drug dosage and form (liquid) is likely the best way to stabilise in the not so distant future. 

 

Edited by eymen23

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Zans
11 hours ago, eymen23 said:

 

Hi Zans,

 

I’m very sorry to hear that you are struggling so much. The near-constant discomfort that you describe can be very hard for people to bear, as it doesn’t allow for much respite or feeling of having a ‘break’ to recuperate and know things will get easier. Please try to remain hopeful and use methods of distraction or self-soothing as much as possible. 

 

Reading through your thread and looking at your signature, it seems your nervous system has become destabilised over time with numerous drugs and changes. Very often we see that the effects of these changes accumulate over time, and eventually it reaches a stage where symptoms seem to persist irrespective of the particular drug or dosage currently taken. 

 

I would suggest a long hold until things start to settle down. Although you might not reach a point of being totally symptom free, you will likely reach a point where symptoms are consistent and tolerable. This is known here as ‘withdrawal normal’. From there you could consider resuming your taper at a gentle pace. 

 

In regards to your mum’s point about most of the tablet staying at the bottom of the liquid, assuming you’re still taking Brintellix, the active ingredient (vortioxetine hydrobromide) is ‘slightly soluble’ in water. From a more practical perspective, this means that 5mg of the drug will dissolve in 5ml or water. So as long as you use at least 5ml or water and remember to stir well, the only part of the tablet staying at the bottom of the liquid should be the inactive ingredients such as fillers. 

 

To me it seems more likely that the change to liquid itself upset your system, in combination with all the changes you previously made and that Chessie outlined. Again, a long hold of your current drug dosage and form (liquid) is likely the best way to stabilise in the not so distant future. 

 

Hey Eymen,

 

thanks for quick and lengthy response. Yeah, unfortunately I quit various drugs CT which might of have delayed reaction. I actually had various symptoms all the time but it was liveable. From September it picked up pace though.

 

I use 10mg mixed with 10ml. I hope that's still fit slightly soluble definition.

 

Again, thank you for reassurance and support. I just couldn't take how bad it is lately. Yet I know it can be even worse.

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