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Redrag

I've been on the max dose of 200mg per day of Sertraline, an SSRI, since 1990. To begin with it was great. I was working faster, and for longer hours, than was really good for me, physically; but the Dopamine "highs" were so rewarding. Sertraline enabled me to cope - and work even harder. I was getting high on the success I was getting from work and get driving harder and harder.

 

In 1996 I had a stroke, but returned to work after one year and resumed my "workaholicism". I never equated the SSRI as a possible contributing factor to my stroke, but that possibility has dawned on me recently. I had been diagnosed with "depression" but, in fact, my doctor should have diagnosed me with "workaholism". I'm not looking to apportion blame for my stroke - I take full responsibility for it - but in the lack of any physiological signs at the time my theory that Sertraline may have supported my "crash" is one that I hang out there.

 

I retired in 2008, but remained on 200mg per day of the SSRI, simply because I had always considered the drug to be a "mood improver", rather than a "work enabler". My theory may be wrong, but I soon came to realise that, without the "high" that hard work was giving me, supported by the SSRI, I didn't like the person I had become during retirement. I assumed it was due to the change in lifestyle and I would soon relax and be more positive. After much reflection, I realised that the SSRI was, in fact, numbing my emotions; I was only ever pretending to enjoy myself and didn't get excited about anything. At first, I was in denial over this and kept organising grand projects and long holidays for myself. I realise that I was simply trying to escape who I'd become. A grandson came on the scene but I was doing all I could to avoid seeing him, my daughter, my friends - everybody. I was/ am like a zombie and I felt I could act as a normal person should anymore. It was as if I had had a chemical frontal lobotomy, the symptoms of which only became apparent when work ceased to be my "raison d'ertre".

 

in 2019 I decided to come off Sertraline and try to recover my personality. I applied to be on a University Trial for psilocybin as a substitute for SSRI but was rejected due to my medical history. I decided to mirror the trial anyway and started tapering at a rate of 10% of the drug per week, commencing in April, 2019. After that, the plan was to wait a further 6 weeks to completely flush-out my system and then to experiment with 25mg of psilocybin. Psilocybin is, of course, an illegal substance in the UK, so I have to guess what weight of magic mushrooms represents 25mg of psilocybin.

 

But, having got to that point, I have become troubled by some side-effects that I had not anticipated. I anticipated mood changes and emotional difficulties but, since mid-way through the tapering process, I have had severe pain in my right hand (the "weak" side following the stroke) and also a developing problem with my right hip. I have also lost all enjoyment of food and drink and have a constant "shooshing" in my head. The list goes on, but these are three most prominent symptoms. I had deliberately not acquainted myself with the possible withdrawal symptoms before I embarked on this because I did not want my subconscious to use them as a "shopping list" for my body! However, I am now preoccupied with a number of questions and feel "paralised" at this point until I can find answers:

 

  • Is the pain, and the other physical symptoms I am experiencing, genuine symptoms of withdrawal, or are they something that the SSRI drug was masking (in the same way that it masked certain emotions)? (There is no physiological damage to any joints).

 

If these are symptoms of withdrawal then:

 

  • Will they ease naturally, and over how long?
  • Will taking the planned alternative medicines help, or hinder recovery from these?

 

If these symptoms were, in fact, entirely separate from the SSRI, but were being "masked" by it, then:

 

  • Are these symptoms of chronic conditions that will only be eased by returning to the SSRI?
  • Or can they be cured by traditional methods?

 

Unless I am prepared to pay mega-bucks, the answers to these questions will only come very slowly. My hand has been examined at the local hospital who gave me a clean bill of health ("perhaps a little arthritis"). Given the severe pain I am experiencing, and have been unable to ease through painkillers, that diagnosis did not provide much reassurance!

 

Anyway, moving on... Although the medical profession is set up very well to put one on to antidepressants, I have found that there is no support for someone coming off them. To be fair, I was offered CBT, but it soon became apparent that this approach was not appropriate. So I feel very alone, frighteningly so. I went back to the University who was conducting the trials into psilocybin and they referred to me cepuk.org; I followed links from their website and this forum is one of those links. In a search for answers I have followed other links from Cepuk and read papers by highly qualified individuals whose opinions vary from:

 

  • Doctor Stuart Shipko, a Californian psychiatrist who has published on SSRI withdrawal, no longer advises patients who have been on SSRIs for more than ten years to try to stop unless they are willing to risk disabling symptoms, including a state of agitation and inner restlessness which he calls ‘tardive akathisia’. He states that his ‘clinical observation is that long lasting symptoms occur even in patients who taper very slowly, not just those who stop quickly, and that there is no guarantee that these symptoms will go away no matter how long the patient waits’.
  • Medicalnewstoday.com, (a site referred to me by my CBT counsellor), which indicates that "Discontinuation symptoms tends to last for 1 to 2 weeks, but can last longer in some cases"

 

So I'm no further forward; that's where I am at present (4 August, 2019). No answers, just more questions; I can only follow my instincts and take all that I read/ hear with a good degree of scepticism.  The story continues.......

 

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Gridley
Posted (edited)

Welcome to SA, Redrag.  Sorry you're having these difficult symptoms.  What dosage are you on now of Sertraline?

 

We recommend tapering no more than 10% of current dose every four weeks.

 

Why taper by 10% of my dosage?

 

Your taper was much faster than our recommendation. Some of the symptoms you describe are classic withdrawal symptoms--the whooshing, which are known as brain zaps, and the loss of interest in food and drink and indeed in life itself, known as anhedonia.  In withdrawal the central nervous system is dysregulated, and since the CNS underlies all bodily functions, withdrawal can result in various, even bizarre, symptoms.  Personally, I have noticed than when withdrawal is bad, weaker areas of my body, such as those affected by previous surgery, tend to act up.  

 

Withdrawal symptoms arise because your body got used to the drug being present and now has to work very hard to accommodate its absence.
 
 
 
You mentioned that your plan had been to allow six weeks to flush the drug out of your system.  Unfortunately, it doesn't work that way.
 
When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  
 
These explain it really well:

 

 

   On 8/30/2011 at 2:28 PM,  Rhiannon said: 
When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.

 

For us to better advise you, we need you to complete a brief drug signature listing the date you started the Sertraline, the date you started the taper, the rate at which you tapered and your present dosage.  Please use this link and click on "save" when you're finished.

Account Settings – Create or Edit a signature.
 
Let me address as best I can some of your questions.  

 

If these are symptoms of withdrawal then:

  • Will they ease naturally, and over how long?
  •  Will taking the planned alternative medicines help, or hinder recovery from these?

 

Some people are lucky and their withdrawal might resolve after a few months.   For some it takes years, and there's no way to predict in which category you'll fall.  

 

How Long Is Withdrawal Going to Take? (this post - see below)

 

Regarding the alternative medicines, here is a link on Psilocybin.  We are not fans of hallucinogens.

 

Psychedelic mushrooms, ayahuasca and other hallucinogens ...

 

One of the posts by Altostrata, the site's founder, says that alternative drugs like this can make withdrawal a lot worse.  We do know that when a person is in withdrawal, that person can be extraordinarily sensitive even to previously innocuous supplements and even foods.  

 

We take a much more optimistic view than Dr. Shipko.  Brassmonkey, one of our moderators, was on a high dose of Paxil for twenty years.  He tapered off slowly and is now a year off the drug and doing very well.  I have been on Lexapro for 15 years and have tapered from 20mg down to 1.9 without serious withdrawal symptoms.  Please Google "SurvivingAntidepressants.org success stories."

 

One option you have is reinstating a very small dosage of Sertraline.  This is the only known way to reduce withdrawal symptoms.  Once you've completed your drug signature, we can advise you on the dosage to reinstate.  Please read:

 

About reinstating and stabilizing to reduce withdrawal symptoms. -- at least the first page of the topic
 
This is your Introduction topic, where you can ask questions, post updates and connect with other members.  We're glad you found your way here.
 
 

 

 

 

Edited by Gridley

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Redrag

Thank you for your helpful post Gridley

 

I haven't read all the links yet, but have added a signature, as you request.

 

Imperial College London have been conducting a trial into psilocybin. I was not allowed to take part because of my stroke in 1996, but I copied their tapering plan, which was 10% per week, with a further 6 weeks at the end, before testing with psilocybin. It may be that, because I have been on Sertraline for so long, Imperial College may have given me a longer tapering regime.

 

Anyway, I will read all the information you have sent me and update my post.

 

Thank you so much for the the time you invested in me.

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Redrag
Posted (edited)

Moved from:  are-we-there-yet-how-long-is-withdrawal-going-to-take

 

Thank you brassmonkey for all these well-written and helpful essays.

 

If I was worried before about the withdrawal symptoms, then I am scared stiff now! My tapering regime was recommended by Imperial College, London, as part of their study into psilocybin as an alternative into SSRIs (I have their 19 page brief which I would be happy to attach - if you fancy a little bed-time reading!).

 

What scares me, having read through your excellent essays, is that I am now expecting a crash to hit me at any time. (Forgive me if I've misinterpreted, by my concentration is very poor at the moment). As I understand it, you probably recommend that I updose to mitigate the risk of a crash, followed by slow tapering.

 

I realise the answers to my questions are probably within this forum, but are you able to guide me in finding answers to these specifics?:

 

What is the recommended tapering process for SSRIs in general, or Sertraline in particular?

What dosage of Sertraline should I updose to, and when should tapering recommence?

 

Thank you for your help.

 

 

Edited by ChessieCat
added topic before moving to intro topic

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ChessieCat

Q:  Could you please clarify what drugs and doses you have taken since the beginning of this year?  Please include the dates.

 

Please list them in this format:

 

Drug name:  date, dose; date dose etc

Drug name:  date, dose; date dose etc.

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Redrag

Of course:

 

2019

Sertraline: Jan 1 200mg; April 26 180mg; May 3 160mg; May 10 140mg; May 17 120mg; May 24 100mg; May 31 80mg; June 7 60mg; June 14 40mg; June 21 20mg; June 28 to July 4 10mg. July 5 0.00mg

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Gridley
4 hours ago, Redrag said:

What is the recommended tapering process for SSRIs in general, or Sertraline in particular?

What dosage of Sertraline should I updose to, and when should tapering recommence?

 

We recommend tapering no more than 10% of current dose every four weeks for SSRIs including Sertraline.   The tapering plan given to you by the college was four times faster than we recommend.  


Why taper by 10% of my dosage?

 

I suggest you reinstate 1.0mg Sertraline.  During the time you've been off the drug you brain has accommodated itself somewhat to zero mg.  These drugs are very powerful and taking too much can further destabilize you.  

 

This link explains how to obtain small nonstandard doses of Sertraline.  As explained in the link, this is done by cutting tablets and weighing doses using the AWS Gemini-20 scale available in the UK on Amazon, making a liquid, or getting a prescription for liquid Sertraline if available in the UK.  

 

Tips for tapering off Zoloft (sertraline)

 

We need to see how 1mg affects you. It will take about a week for it to get to steady-state in your bloodstream; the effect should get stronger during that time.
 
If it seems you need a higher dose, it will be easy to very carefully increase it by using the liquid.
 
If you reinstate, please keep daily symptoms notes so that you can see how reinstatement is going.  This is an example:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

Please post these notes here daily.

 

Tapering should not recommence until you have stabilized, which will take some months.  It's impossible to say how many months as it varies according to the individual.

 

Please put the information you provided in your previous post into your existing signature.  Here's the link:

 

Account Settings – Create or Edit a signature.

 

2019

Sertraline: Jan 1 200mg; April 26 180mg; May 3 160mg; May 10 140mg; May 17 120mg; May 24 100mg; May 31 80mg; June 7 60mg; June 14 40mg; June 21 20mg; June 28 to July 4 10mg. July 5 0.00mg

 

Please be aware that the vast majority of doctors, including psychiatrists, have no concept of safe tapering or extended withdrawal from SSRIs.


 

 

 

 

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Redrag

Thank you Gridley

 

Must admit that what I read about "crashing" if I taper too quickly spooked me quite a lot. Calmed down a bit now!

 

I will see my doctor about getting a 1mg Dose of Sertraline (cutting a 100mg tab of Sertraline into 1mg slices is a little ambitious for me!).

 

 

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Gridley
Posted (edited)
48 minutes ago, Redrag said:

I will see my doctor about getting a 1mg Dose of Sertraline

 

You could also ask a pharmacy if liquid Sertraline is available in the U.K. and get your doctor to prescribe it for you.  Then you can measure out 1mg yourself.   

 

I'm glad you're feeling better.   

 

 

Edited by Gridley

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Redrag

Saw my doctor today. She is unaware of whether Sertraline is available in liquid form; same story at the pharmacy. Unwillingness to look "outside the box" at this issue. I will need to go to the Private Sector if I need something out of the ordinary. Doctor prescribed 50mg tabs of Sertraline (1 per day). I don't want to go there and I'm sure you agree(?). I'll research the private option.

 

Doctor also prescribed Co-codamol (max 60mg each dose, 4 times a day) for the pain in my hand. A decent night's sleep will be lovely! I see a specialist about my hand on Thursday; I've already "flagged up" that the pain is probably due to WD symptoms and is not necessarily an injury or arthritis.

 

Progress - I hope! Thank you for your support.

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Redrag

Thank you ChessieCat

 

I'd overlooked that link re Zoloft; thank you.

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Redrag
On 8/5/2019 at 4:39 PM, Gridley said:

 

We recommend tapering no more than 10% of current dose every four weeks for SSRIs including Sertraline.   The tapering plan given to you by the college was four times faster than we recommend.  


Why taper by 10% of my dosage?

 

I suggest you reinstate 1.0mg Sertraline.  During the time you've been off the drug you brain has accommodated itself somewhat to zero mg.  These drugs are very powerful and taking too much can further destabilize you.  

 

This link explains how to obtain small nonstandard doses of Sertraline.  As explained in the link, this is done by cutting tablets and weighing doses using the AWS Gemini-20 scale available in the UK on Amazon, making a liquid, or getting a prescription for liquid Sertraline if available in the UK.  

 

Tips for tapering off Zoloft (sertraline)

 

We need to see how 1mg affects you. It will take about a week for it to get to steady-state in your bloodstream; the effect should get stronger during that time.
 
If it seems you need a higher dose, it will be easy to very carefully increase it by using the liquid.
 
If you reinstate, please keep daily symptoms notes so that you can see how reinstatement is going.  This is an example:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

Please post these notes here daily.

 

Tapering should not recommence until you have stabilized, which will take some months.  It's impossible to say how many months as it varies according to the individual.

 

Please put the information you provided in your previous post into your existing signature.  Here's the link:

 

Account Settings – Create or Edit a signature.

 

2019

Sertraline: Jan 1 200mg; April 26 180mg; May 3 160mg; May 10 140mg; May 17 120mg; May 24 100mg; May 31 80mg; June 7 60mg; June 14 40mg; June 21 20mg; June 28 to July 4 10mg. July 5 0.00mg

 

Please be aware that the vast majority of doctors, including psychiatrists, have no concept of safe tapering or extended withdrawal from SSRIs.


 

 

 

 

I've held off reinstatement in the hope that things will improve but, if anything, the anxiety aspect of my withdrawal symptoms has worsened. Nothing appears constant: one or two symptoms appear to have eased, but others (anxiety, in particular) seem to have worsened.

 

So I've now reinstated at a rate of 1mg Sertraline per day.

 

Practical issue: Sertaline tabs won't dissolve. I've crunched them to a coarse powder and I swill the solution to ensure a good mix before taking a dose.

 

What scares me is the question as to whether what I am experiencing are withdrawal symptoms, or whether this was going to be the "norm" for the rest of my life. Thus, if I don't see a reduction in "withdrawal symptoms" over the next two weeks I feel it will be the case of the lesser of two evils and a return to a full dose of Sertraline - or whatever my doctor may suggest.

 

I fee like I've failed, but I can't continue like this in the hope that things will improve. My ability to think quickly and clearly has been stripped from me; what I'm writing now is a rare excursion into clarity but, even now, my concentration is wavering. I can't contemplate any in-depth research into anything at all - my brain just fogs over and I get more and more frustrated with myself. Vicious circles.

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ChessieCat
12 minutes ago, Redrag said:

if I don't see a reduction in "withdrawal symptoms" over the next two weeks I feel it will be the case of the lesser of two evils and a return to a full dose of Sertraline - or whatever my doctor may suggest.

 

Please carefully read Post #1 of About reinstating and stabilizing to reduce withdrawal symptoms .  We have members here who have reinstated too high a dose and things have got much worse.

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Redrag
3 hours ago, ChessieCat said:

 

Please carefully read Post #1 of About reinstating and stabilizing to reduce withdrawal symptoms .  We have members here who have reinstated too high a dose and things have got much worse.

 

Thank you ChessieCat, that makes perfect sense.

 

There is no doubt that I am suffering symptoms of hyper-sensitivity and/ or alerting so I wonder how effective the reinstatement 1mg per day will be - and, if so, where I go from here. And that nagging doubt that the symptoms I am experiencing are not withdrawal symptoms at all - just the new "norm".

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ChessieCat
16 hours ago, Redrag said:

Practical issue: Sertaline tabs won't dissolve. I've crunched them to a coarse powder and I swill the solution to ensure a good mix before taking a dose.

 

It might be better to put the tablet/powder in water several hours before to allow it to dissolve better.  Generally what doesn't dissolve are the tablet fillers.

 

12 hours ago, Redrag said:

And that nagging doubt that the symptoms I am experiencing are not withdrawal symptoms

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

2019

Sertraline: Jan 1 200mg; April 26 180mg; May 3 160mg; May 10 140mg; May 17 120mg; May 24 100mg; May 31 80mg; June 7 60mg; June 14 40mg; June 21 20mg; June 28 to July 4 10mg. July 5 0.00mg.

Sertraline reinstatement: 30 August 2019 1.0mg per day

 

You've gone from 200mg in April 2019 to 0mg in less than 3 months.  I think you say with reasonable certainty that you are experiencing withdrawal symptoms from getting off your drug too quickly.

 

This is what happened to me.  I was taking 100mg Pristiq and started taking 50mg.  Over a 2 week period my brain fog got worse and worse and even walking took my full concentration.  It was at this time that I researched and found SA.  A couple of days after joining SA I was unable to type.  I have been a professional typist for 40+ years so I knew something was wrong.  I decided to take extra Pristiq and after only about 4 hours I was able to type again and the brain fog was lifting.  I had a benchmark so I had proof that it was the lack of drug that caused the brain fog and inability to type.  The difference was like night and day.  I also knew that there was no way that this was wishful thinking etc. 

 

12 hours ago, Redrag said:

I wonder how effective the reinstatement 1mg per day will be

 

SA recommends starting with a small dose to see how you respond.  The idea of reinstating isn't to get rid of withdrawal symptoms completely but to bring them to a bearable level.  It takes about 4 days for a dose to get to full level in the blood and a bit longer for it to register in the brain.  It is better to start with a small dose than to risk taking too much, which might make things worse.  You will need to be patient and try not to panic.  When we panic we can make bad decisions.

 

Please keep notes on paper of your symptoms so you can see how the reinstatement is affecting your symptoms.  If your symptoms are still unbearable after 1 week on 1mg you might want to increase to 2mg.  If you aren't sure then you would stay on 1mg for 2 weeks and then reassess.

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Redrag

Thanks, again, for your support, ChessieCat

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Redrag

I'm not sure if my withdrawal symptoms have become bearable or if I've simply become accustomed to them and developed my own coping strategies. What is the potential downside of increasing to 2mg per day?

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ChessieCat

It's a large increase.  If you are currently taking 1mg sertraline and you can live with the symptoms it might be better to hold on that dose.

 

If you do decide to increase you might find 1.25mg to be enough.  The idea of reinstating isn't to get rid of symptoms completely but to bring them to a bearable level.

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Redrag

Thank you for your prompt response, ChessieCat; I'll increase to 1.25mg and hold there.

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Redrag

Actually, it's pretty unbearable. My doctor wants me to go back onto 50mg Sertraline; what will happen to me if I do?

 

Even going back to my zombie-like state is preferable to this.

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Dejavu

Redrag, no one can tell you for certain what will happen, but that is a whopping high dose for a sensitized nervous system to handle. You risk kindling yourself with this kind of updose, and your symptoms then become much worse rather than better. Most doctors do not understand this, but it's akin to throwing gasoline on a fire. There is certainly no guarantee that you will return to your previous state, as you are hoping.

 

You have only updosed to 1.25 yesterday. That is definitely not enough time. It takes about 4 days for a dose change to reach steady state in the body, and a few days longer than that in the brain. I would urge you to resist the temptation to updose any further and give the 1.25 a chance. I know it seems crazy, but these drugs are very powerful, and a little bit goes a very long way, especially with a CNS already sensitized by withdrawal. More is not better.

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