Worthy: tapering advice wanted

[manymoretodays]

On 3/17/2020 at 8:54 AM, Worthy said:

 I know my situation is unique due to my circumstances but do you think I will be ok.  I started these drugs in July last year and started tapering in August.   I am very very scared 😱 

 

Worthy,

I cannot assure you that you will be okay.......I mean, no doubt you are already struggling with WDsyndrome and a mucked up nervous system from some rapid changes in all 4 meds.

Just no, I am not on board with your plan at all.

 

On 3/17/2020 at 8:54 AM, Worthy said:

Thanks.  I am tapering at 2% every two weeks and will continue to,do this for at least another year as I have enough medication for me to do this,   I am currently on 1.24 mg zyprexa, 13.7 mg cymbalta, 5.5 mg mirtazapine, .38 mg Ativan.   I know the advice is to taper only one at a time but if I am likely to run out due to unavailability surely it is better to do a slow, taper on all of them at once rather than having to go cold turkey at the end?

 

If I am reading correctly, you want to do 4 % off each drug, every 4 weeks.  Meantime, you have a years supply of medications to work with???  Why do keep ideating on a CT, a year from now anyway?  We've advised you already above, or made suggestions.  Did you look at your drug interactions?  Might you try to do a signature?

 

Best,

L, P, H, and G,

mmt

 

Keep us updated, if you'd like to, as to how you are doing, and what you are doing.  We can always try and help you find non-drug coping skills for dealing with WDsyndrome.  Your situation is not especially unique here.......I mean you are, of course........but we see this kind of over zealous, irrational, over  medication picture all.....the .......time.  Going too quickly off and all of them at the same time.......can really jeopardize your nervous system.  I don't even know or see any report on how long you've been on this wild polypharmacy.

 

 

[Worthy]

Thank you for your comments.  I have said how much i am reducing by; when i started and when i started tapering and the dose.  I believe 2% every 2 weeks is not a fast taper.  The drugs are not available in Zimbabwe so my feeling is it is better to do a slow taper with the pills i have.  Please can you tell me what symptoms i will be having if it is affecting my nervous system.  If i am to taper all of them one at a time it will take me about 9 years.  I As i mentioned i am.unable to get any more pills as they are not available.  

[manymoretodays]

Hi Worthy,

I went ahead and added the information from your January 8th post to your signature:

I started tapering on 25th July last year 2019.

2020, as of January 8:

1.6 mg on zyprexa out of 5 mg at night

6,9 mg mirtazapine out of 15 at night

23mg cymbalta out of 60 at night

I have not yet started the Ativan taper (1mg morning)

Signatures, are seen below each members posts, unless viewing from some phone devices and give us information, at a glance, wherever you might post on the site.

More here about them:  Please put your withdrawal history into your signature

Please update and date recent changes to your meds/drugs here:  Account Settings/signature

You might just keep going, with the above signature now, and when you add taper changes, do it next to each applicable medication.  The current system just allows for 12 lines in signatures.

Don't forget to hit the Save button at the bottom when you are done.

 

Any prior medication history?  And I'm still wondering when you started each of these medications?

 

10 hours ago, Worthy said:

Thank you for your comments.  I have said how much i am reducing by; when i started and when i started tapering and the dose.  I believe 2% every 2 weeks is not a fast taper.  The drugs are not available in Zimbabwe so my feeling is it is better to do a slow taper with the pills i have.  Please can you tell me what symptoms i will be having if it is affecting my nervous system.  If i am to taper all of them one at a time it will take me about 9 years.  I As i mentioned i am.unable to get any more pills as they are not available.  

 

No, that's not too bad, as far as tapering percentage.  It's just that you have some drugs with interactions, and as you change the dose of one, it may affect the metabolism, of another.  Posting for you, your interactions check:  https://www.drugs.com/interactions-check.php?drug_list=949-2273,1744-1113,1640-0,1488-899

(and will get to WD symptoms you might experience, or have been experiencing in another post)

Interactions between your drugs

Major

LORazepam OLANZapine

Applies to: Ativan (lorazepam), Zyprexa (olanzapine)

Ask your doctor before using LORazepam together with OLANZapine. This can cause low blood pressure, shallow breathing, weak pulse, muscle weakness, drowsiness, dizziness and slurred speech. This may be more likely to occur in older adults or those with a debilitating condition. You should be counseled to avoid activities requiring mental alertness until you know how these medications will affect you. If your doctor prescribes these medications together, you may need a dose adjustment or special tests to safely use these medications together. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

 

Major

mirtazapine DULoxetine

Applies to: mirtazapine, Cymbalta (duloxetine)

Using mirtazapine together with DULoxetine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

 

Moderate

LORazepam mirtazapine

Applies to: Ativan (lorazepam), mirtazapine

Using LORazepam together with mirtazapine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

 

Moderate

LORazepam DULoxetine

Applies to: Ativan (lorazepam), Cymbalta (duloxetine)

Using LORazepam together with DULoxetine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

 

Moderate

mirtazapine OLANZapine

Applies to: mirtazapine, Zyprexa (olanzapine)

Using OLANZapine together with mirtazapine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

 

Moderate

OLANZapine DULoxetine

Applies to: Zyprexa (olanzapine), Cymbalta (duloxetine)

Using OLANZapine together with DULoxetine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

No other interactions were found between your selected drugs. This does not necessarily mean no other interactions exist. Always consult your healthcare provider.

 

Edited March 20, 2020 by manymoretodays
grammar, clarity

[manymoretodays]

Okay, hi again.  Worthy, and there is more about food and alcohol effects, with your drugs, and duplication, that I want to be sure that you are aware of.  So will you also go and look at that link too, the drug interaction one, and read toward the bottom on those two items.  Please?  Just so you are being safe and all.

 

 

Who prescribed this cocktail to you?

10 hours ago, Worthy said:

Thank you for your comments.  I have said how much i am reducing by; when i started and when i started tapering and the dose.  I believe 2% every 2 weeks is not a fast taper.  The drugs are not available in Zimbabwe so my feeling is it is better to do a slow taper with the pills i have.  Please can you tell me what symptoms i will be having if it is affecting my nervous system.  If i am to taper all of them one at a time it will take me about 9 years.  I As i mentioned i am.unable to get any more pills as they are not available.  

 

And yes, it's often the case that tapers can extend that long.  We have a couple members, who ARE able to do some multiple medication tapers, usually not all at the same time, but by doing alternating months of tapering, for some time.   What is perhaps, more important than the total time of tapering off medications, is reducing the possibility of dangerous interactions, as well as getting to lowered doses, as lowered doses often carry less chance of adverse effects, or long term adversities.  So.....there is that to consider.  As well as this:

 

I'll post this again for you here:  

Tapering multiple psych drugs? Which drug to taper first?

And then Alto's best suggest, as well, based on your reporting the  unlikelihood, of getting further prescriptions:

On 2/13/2020 at 5:50 PM, Altostrata said:

Worthy, if you cannot get continued prescriptions for your drugs, not sure how we can help you. We advocate careful tapering of one drug at a time. This requires a prescription throughout the process.

 

If you've made cuts in all your drugs at once, you're already probably suffering from withdrawal symptoms from any or all of them. Further reductions likely will make withdrawal worse.

 

Given all your choices are bad, if I were you, I'd go off Cymbalta first, tapering as best you can by taking beads out of the capsule, while staying on Zyprexa, mirtazapine, and Ativan. When you're off Cymbalta for a month, I'd taper mirtazapine. After that, Zypreza. Ativan would be last.

 

This is by no means a good plan that will help you avoid withdrawal syndrome, but it may enable you to sleep through most of the tapering.

 

Taking Cymbalta, Zyprexa, and mirtazapine together at night makes no sense at all. For your own information, put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php and copy and paste the results or a link to them in this topic.

 

To help us out, follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this. Did this for you.

 

Edited March 20, 2020 by manymoretodays

[manymoretodays]

And okay, finally, to your questions about WD(withdrawal symptoms).

  

10 hours ago, Worthy said:

Thank you for your comments.  I have said how much i am reducing by; when i started and when i started tapering and the dose.  I believe 2% every 2 weeks is not a fast taper.  The drugs are not available in Zimbabwe so my feeling is it is better to do a slow taper with the pills i have.  Please can you tell me what symptoms i will be having if it is affecting my nervous system.  If i am to taper all of them one at a time it will take me about 9 years.  I As i mentioned i am.unable to get any more pills as they are not available.  

 

What kind of symptoms are you having Worthy and when?

Oh boy, WD symptoms can run the gamut, there are many.  Here is one list from Dr. Glenmullen's book:

Dr. Joseph Glenmullen's withdrawal symptom checklist

See which ones, you might be having that correlate with ^

 

I think it would be really great too, if you would do a drug and symptom type diary/notes too.  Here is what I am referring to:

Keep daily notes

^ is really pretty simple, take a look at the first post in that link, there is a sample note, you could follow, and then post one 24 hour segment, right here, on your introduction page.

Make sure and note all drugs, by name, with doses, and supplements, and brief symptom notes, and sleep to the right of the times.  It can really help keep you organized and helps us, to make better suggestions to you.

 

And okay, another basic, introductory concept, around drug/med WD:

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.  The CNS likes stability. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur. And sleep is really important during withdrawal. 

 

Will include again: 

What is withdrawal syndrome?

Brain remodeling
The windows and waves pattern of withdrawal stabilization

 

Just so you have everything here now, in your introduction, so you can refer back to links, to read more and learn more, as to what is going on.  Knowledge is power, Worthy.

 

Coping with WD symptoms:  Symptoms and Self care forum   

.......is full of some really good stuff that might help, and lot's of member topics as well.  Take a look at some of the top "pinned" topics when you can.  And certainly post right here, on your introduction, around you specific symptoms too.  Then we can help you find or recommend non-drug coping skills and practices specific to your symptoms.

 

And so....  I know that's a lot of information Worthy.  Like I said, good, I think, for you to have it here, to refer to now.  I don't expect you to have read through everything right away.

 

I'd really like to see some daily notes though, so focus on those(link above in this post on how tos) first please.  We might want to recommend some different spacing to your medications, or something to that effect that might be helpful.  We can't really do that without knowing what a typical day looks like......including your drugs and symptoms, as they are taken, and as they occur.

 

Best, L, P, H, and G,

mmt

 

Just adding in here:  if you could just HOLD doses, right now Worthy, that would be great.  You sound a bit better than when you first began posting here and that is good.

 

 

Edited March 20, 2020 by manymoretodays
HOLD

[Altostrata]

Hello, people have been guessing at tapering schedules for 30 years. That is where withdrawal syndrome comes from -- people tapering too fast because there are no guidebooks.

 

You can believe your taper is not too fast, but your nervous system is the final judge. However, any taper is better than none.

 

You may get withdrawal symptoms from any mode of tapering. As manymoretodays suggested, keeping daily notes of your drug schedule and symptom pattern may enable you to recognize withdrawal symptoms when they occur. If they do occur, what's important is to STOP TAPERING, stabilize for while (could be months), and resume with more gradual taper.

 

There are many papers about withdrawal symptoms. @manymoretodays gave you some links to some lists.

 

We advise slow tapers to minimize withdrawal symptoms: Why taper by 10% of my dosage?

 

Also see: Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration

 

If you have to taper more than one drug at the same time -- which we very much DO NOT recommend -- with your own schedule and you get withdrawal symptoms, you may get yourself into a complicated situation that may exceed the capabilities of volunteer peer support. In short, we may not be able to dig you out. All we can do is counsel you to cope with withdrawal syndrome.

 

Good luck!

[Worthy]

Thank,you so,much for all your help.  I have managed to,source Ativan and mirtazapine so going to hold,on those for a while.  As i have not managed to,secure more zyprexa and cymbalta I am continuing to taper those 2 together.  I would prefer to,do,that rather than run out cold turkey at the end.  I am going to taper at 5% every 2 weeks.  Do you think this will help mymwithdrawl symptoms 

[manymoretodays]

Hi Worthy,

Are you then upping your tapers of 2 now, from 2% to 5% every 2 weeks.

What are your WD symptoms? 

Usually........we counsel a HOLD period, or longer HOLD, if and when WD symptoms come up.  To allow your nervous system, a bit more time, to re-adapt, or readjust after a taper.  Or smaller percentages of tapering.

 

Did you see the notes link?  Why are you taking cymbalta at night?

Keep daily notes of drug schedule and symptoms to track patterns and progress

Please look at the ^, and I copied over some of it right here

- Time and dosage for all drugs taken throughout the day, psychiatric and non-psychiatric.

- Following each dose, note any symptoms. If you are having a reaction to the drug, it may take hours for a symptom to show up -- that's why we ask you to keep notes all day long.

- If you're not taking any drugs, your symptoms throughout the day.

- Your sleep pattern. Since so many drugs disturb sleep, if you find you're waking in the middle of the night, it could be from a drug you took earlier in the evening. If you're not taking any drugs, there may be ways you can improve your sleep.

And so forth. A diary, in chronological order, looking something like this:
 
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

 

I think this might be really helpful to do, this, the notes.  And then post a day, 24 hours, right here.  Thanks.

 

L, P, H, and G,

mmt

[Worthy]

How safe is it to quit olanzapine at a dose of  1.25 mg.  I started on 5 and have tapered down to 1.25mg.  .  I have been tapering since August along with 3 other AD’s and I feel olanzapine is the safest drug to stop first as it is the lowest dose.   I would like to stop olanzapine at this dose if anybody thinks it is low enough.  

[manymoretodays]

Hi Worthy, @Worthy

 

Tips for tapering off Zyprexa(olanzapine)

 

And how long have you been on all your medications?  I do see that you began tapering on 25th of July last year 2019.

Account Settings/Signature update

^ this should take you to your signature to update, and add in some additional dates

If your drug history is very long, the last few years will do. FOR READABILITY, SHORT LINES ARE BEST.

 

• A list is easier to understand than one or multiple paragraphs
• Include ALL drugs, doses, and dates (starting and stopping)
• Any drugs prior to 24 months ago can just be listed with start and stop years
• Please use actual dates or approximate dates (e.g. mid-June) rather than relative time frames (e.g. 3 months ago)
• Spell out months (e.g. "January" or "Jan" as 9/1/2016 can be interpreted as 9 Jan 2016 or 1 Sept 2016)
• Please leave out symptoms and diagnoses

 

Example:

2001–2002 paroxetine 
2003  citalopram 
2004  paroxetine
2008  paroxetine slow taper down to 2016 Aug off paroxetine
2016  citalopram May 20mg  Oct slow taper down
2018  citalopram 13 Feb 4.6mg 15 Mar 4.4mg 29 Apr 4.2mg

 

Just hit the SAVE button when you are done.

 

What are your symptoms like at present?

1.25 mg of Zyprexa, is not necessarily a low dose, and may be way to high of a dose to jump off of now.  Different medications have different ranges of usual doses that they are prescribed at.  For the most part, most members do best, jumping off ,well below even the 1 mg dose.

 

Can you give a try at notes please?

Just hit the arrow at the top right, and it will take you to my post, requesting these back in January.  It's pretty simple.......really.  And so helpful, when trying to answer your questions.

 

I came off Zyprexa, while on at least one other medication, quite some time ago.  And it was fairly brutal.......as I came off of it at way too high a dose........took me some time to recover.  Sorry, but bad recollection of that time period, as I was in WD then, while getting continously re-medicated for it, as well.  I suspect it might have been 1.25 mg and yes, way to high of a dose, for me to come off of.  It wasn't just the sleeplessness, or insomnia.........my sensorium, or perception of things was very skewed and off, and negative.

So please, don't do what I did.  It was long before I had gotten here, in anycase.  And most likely years and years were added to my eventual recovery and healing.  So come on, Worthy.......try to shift a bit, and listen, and read, and above all.........help us out, with information, when you ask questions.  Notes please.  The last link I gave you above.  Give it your best effort.

 

Thank you.

L, P, H, and G,

mmt

 

You can search for other members tapering Zyprexa too, if you would like.  Just put Zyprexa in in the top right search box, on site.  Or.......survivingantidepressants.org Zyprexa/olanzapine..........in your main browser, off site.

 

 

Edited April 6, 2020 by manymoretodays

[Worthy]

I am thinking of cold turkeyingn on my mirtazapine but continuing my taper with my other drugs. I believe mirtazapine is the least dangerous of all,the drugs I am on.  Please can anybody let me know how,easy it is to,taper mirtazapine

[Worthy]

What is the highest dose I can jump,off zyprexa.  I am currently at 1.25 and I am wanting to,get off as soon as possible.   I would appreciate any comments

[Altostrata]

On 4/6/2020 at 12:33 AM, Worthy said:

How safe is it to quit olanzapine at a dose of  1.25 mg.  I started on 5 and have tapered down to 1.25mg.  .  I have been tapering since August along with 3 other AD’s and I feel olanzapine is the safest drug to stop first as it is the lowest dose.   I would like to stop olanzapine at this dose if anybody thinks it is low enough.  

 

1 hour ago, Worthy said:

What is the highest dose I can jump,off zyprexa.  I am currently at 1.25 and I am wanting to,get off as soon as possible.   I would appreciate any comments

 

1 hour ago, Worthy said:

I am thinking of cold turkeyingn on my mirtazapine but continuing my taper with my other drugs. I believe mirtazapine is the least dangerous of all,the drugs I am on.  Please can anybody let me know how,easy it is to,taper mirtazapine

 

Please do not start new topics about your tapering plan. See responses earlier in this topic.

 

Cold-turkeying Zyprexa at 1.25mg and mirtazapine at whatever dosage you're taking is high risk for withdrawal symptoms.

 

You keep on asking us to give you ways to go off your drugs that are fast and high risk. We don't do that here. We cannot tell you what will happen. Quit psychiatric drugs suddenly at your own risk. There is no reason to keep asking us about it. We don't recommend it.

 

On 3/23/2020 at 7:36 AM, Worthy said:

Thank,you so,much for all your help.  I have managed to,source Ativan and mirtazapine so going to hold,on those for a while.  As i have not managed to,secure more zyprexa and cymbalta I am continuing to taper those 2 together.  I would prefer to,do,that rather than run out cold turkey at the end.  I am going to taper at 5% every 2 weeks.  Do you think this will help mymwithdrawl symptoms 

 

Since you said you have enough mirtazapine to taper, do not understand why you are planning to cold turkey it.

 

You seem to have a great interest in cold turkey. There is no safe way to cold turkey. The way you're going off drugs is haphazard and high risk -- as we've told you many times.

[Worthy]

On 2/9/2020 at 5:26 PM, Gridley said:

 

We recommend tapering only one drug at a time because, if there are problems, you won't know what drug taper is causing it.

 

Wel also recommend tapering activating drugs, which are called accelerators, leaving the more sedating drugs which are called brakes, to act as a cushion or buffer to be tapered later.

 

Taking multiple psych drugs? Which drug to taper first?

 

Cymbalta is an accelerator.  Mirtazapine is also an accelerator but has some qualities of a brake.  Zyprexa and Ativan are brakes.  I would recommend you continue your taper of Cymbalta and hold where you are on the other three.

 

5% every two weeks is in line with our guideline to taper no more than 10% of current dose (NOT original dose) every four weeks.

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering Cymbalta.

 

Tips for tapering off Cymbalta (duloxetine)

 

Please answer the questions that manymoretodays asked in her last post.  Here's what she asked:

 

Hi Worthy, @Worthy

Can you do something like this for us?  We really need more precise information.  Take a look at the following link and then try and just give us a day of times noted on the left, drugs by name and dose on the right, and symptoms throughout the day on the right as well.  Include sleep and any other substances or supplements taken.

Keeping Daily Notes

 

Example/sample:

DATE:

 

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

 

Do this, but with your own drugs and symptoms.  That will really help.  

 

 

 

 

 

 

 

[Worthy]

Thank you for your reply.  I have been thnkimg long and hard about your reply.  If I do one drug at a time it will take me a very minimum of 8 years if I taper at 5% every two weeks.  I am 66 years old now so will be over 70 when I finish.  Please confirm 5% every 2 week’s is the highest safest rate to taper.  My other problem is I am a pensioner with no medical insurance so struggling to,pay for the pills.  Also availability is a problem where I live.  A huge dilemma but I reallly would value your help.  

[Altostrata]

5% every 2 weeks is the same as 10% every month. You might find 5% reductions every 2 weeks to be more comfortable than a 10% drop all at once.

 

I cannot predict the best tapering schedule for you. You will have to see how your nervous system reacts to a dosage reduction. If you get withdrawal symptoms, you're going too fast. It's up to you to listen to your body to find out how fast a taper is tolerable.

 

Depending on how you react to  5% reduction, the effect of which you should observe for several weeks, you may be able to reduce at 5% per week. (The reduction is calculated on the last dosage, with the amount of reduction getting progressively smaller for a smooth ramp off the drug.)

 

You will want to taper one drug at a time so you can see how your nervous system reacts. If you taper more than one drug at a time and it's a disaster, you won't know which drug to reinstate. That will be a mess.

 

I am sorry this may be difficult, expensive, and take a long time, but that's what happens when you're taking a bunch of psychiatric drugs.

 

Here are your drug interactions. Do you have any of these symptoms? You may wish to taper the one causing the most problems first.

 

[Gridley]

22 minutes ago, Worthy said:

Thank you for your reply.  I have been thnkimg long and hard about your reply.  If I do one drug at a time it will take me a very minimum of 8 years if I taper at 5% every two weeks.  I am 66 years old now so will be over 70 when I finish.  Please confirm 5% every 2 week’s is the highest safest rate to taper.  My other problem is I am a pensioner with no medical insurance so struggling to,pay for the pills.  Also availability is a problem where I live.  A huge dilemma but I reallly would value your help.  

 

I sympathize completely.  I'm 71 and as you can see from my signature it will be several more years before I'm off all my drugs.  The problem with going off more than one drug at a time is, as I said, if there's a problem (such as your withdrawal symptoms become too difficult, meaning you're tapering too fast) you won't know what's causing the problem and are left to guessing.  Am I tapering this drug too fast or this drug?  Should I hold on this drug or this drug?  Do I need to updose this drug or that drug?  With several drugs in play, the possibilities are virtually endless and the chance you'll guess wrong is strong.   Of course, you're free to taper any way you want, but that is a real concern that we have here about tapering more than one drug.  There is one member here, Rhiannon, who tapered several drugs at once, but she's very attuned to her symptoms and what worked for her might not work for others.

 

As far as the rate of taper goes, the 5%/2 weeks or 10%/4 weeks is what's been found to work generally for most people.  Some can go faster, but the only way to find out is to try it, and if you throw yourself into a too severe withdrawal, it will take extra time for you to hold in order to stabilize or to updose and stabilize, and there's no guarantee that an updose will work and you could be left to suffer from withdrawal for no one can tell how long.  

 

A method that some members have used with success is to taper one drug for a while, then another for a while.  This could help with your supply problem if it's particularly hard getting one of your drugs.  Before I discovered SA, I tapered Imipramine from 75mg down to 15mg before discovering here that it was a sedating drug and I should have been tapering the activating drug, Lexapro, first.  The benefit of this was that I preserved my supply of Imipramine (which is unavailable in Ecuador where I live).  But it came with a cost: I had severe withdrawal that lasted for months that only abated when I updosed to 25mg and it took several months for the updose to work.  That's the argument for tapering the activating drug, in your case Cymbalta, first.

 

I'm sorry you're in this difficult situation.

 

[Worthy]

I have decided to stop multi tapering as I am struggling too much.  I have read the article on multi tapering but am confused as I am on so many different drugs.  Is anybody able to advise me which order I should do my taper.  I am on olanzapine (an anti psychotic), cymbalta, (Not sure what class of drug) mirtazapine ( tetracyclic) and Ativan (benzo).  Please can somebody help as I am struggling.  

[Altostrata]

We do not recommend multi-tapering, as explained to you many times before.

 

It might be a good idea for you to stay on all your current dosages and let your nervous system settle down for some months.

 

 

[ChessieCat]

 

I've merged your new topic with your Introduction topic.  This is the best place to ask questions about your own situation.  This keeps all your information in one place.

 

53 minutes ago, Worthy said:

cymbalta, (Not sure what class of drug)

 

Cymbalta is an SNRI antidepressant.  The majority of antidepressants are SSRIs.

 

 

Edited June 7, 2020 by ChessieCat
Deleted some info because Alto posted just before me

[Worthy]

thank you for your help.  As you know I am finding it hard to source the drugs as they are not available where I live  and have no medical insurance.  I cannot stabilize for some months so doing the best I can in a very difficult situation.   Which drug would you recommend I taper first. I am at very low doses on all of them so realize this may be my problem.    I realize it is not easy to advise me but please I need some one to try and advise the best order of taper.  I live in a country that is currently experiencing huge economic decline and medical supplies are exceptionally difficukt to source.   I am feeling quite desperate and needing help in the difficult position I find myself in.  

 

Edited June 13, 2020 by ChessieCat
deitalicised

[Altostrata]

Very sorry you're in this position. Unfortunately, no matter where you are, it's like the law of gravity: If you taper too fast, you will get withdrawal symptoms.

 

Since you already have withdrawal symptoms, if you reduce any of your drugs further, you are likely to get worse withdrawal symptoms.

 

Would you mind disclosing exactly what you're taking now, at what times of day (o'clock) and dosages?

[Worthy]

Thank you for your reply.  I am taking olanzapine .9 mg and mirtazapine 3.2 mg and .32mg Ativan at 10pm just before I go to bed.  I am taking cynnbalta 13.5 mg at 7am.  I have been tapering by 5% every two weeks.    I have been tapering since August 2019 at that rate.  

[Worthy]

Seeing the drugs i am on and the dosages please can you advise me on the best way forward. I really would appreciate your help. I cannot bear the thought that my withdrawl can get worse and i am feeling very scared.  

[Altostrata]

Since you already have withdrawal symptoms, there is no way for you taper that will cause withdrawal symptoms to go away.

 

Why are you taking olanzapine .9 mg, mirtazapine 3.2 mg, and .32mg Ativan together at 10 p.m.?

 

Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right

[Worthy]

I really appreciate you trying to help me.  I am taking olanxaoine, mirtazapine and ativan st night as that is what the dr prescribed.  I am no longer seeing the dr as i have completely lost my trust in her.  I saw her when i was put in a clinic for supposed depression. I was in fact suffering ftom going CT on zopiclone but nobody realised that until i had been poly drugged.   The dr apologised for the wrong diagnosis and that was the last time i saw her as she lives in a neighbouring country.   Her advice was to fo a rapid taper on all the drugs.  

 

[Worthy]

If I do the 24 hour list format do you think you may be able to help me or is it too late for help.  You mention that there is no way my withdrawal symptoms will go away.   Should I hold for now and wait for your advice on how to continue with my taper.   

[Worthy]

Please let me know if this is roughly the type of list format I need to submit

 

10 pm. Took olanzapine, mirtazapine and Ativan 

4am went to sleep 

6am woke up with extreme anxiety

7am took cynbalta and had light breakfast

8 am home schooled grandchildren for 2 hours 

10 am to 4pm extreme anxiety

4pm to 6pm tried to do chores but very little concentration.  Went for a walk

6 pm ate very light meal

 

 

Edited June 15, 2020 by Worthy
Changed times

[Altostrata]

The format is fine. You need to put in the DOSAGES of each drug each time you take it.

 

You are getting breakthrough withdrawal from taking Ativan once a day. Is your Ativan in a 1mg tablet? If I were you, I would cut it in half and take 0.5mg at 10 a.m. in the morning and 0.5mg at 10 p.m. in the evening. This should reduce the anxiety that starts in the morning. 

 

Let us know how you're doing. If this goes well, you can start reducing one of the other drugs you're taking at night.

 

[Worthy]

Thanks.  I have started taking the Ativan twice a day.  I have also started to taper the zyprexa at 3% every two weeks.   I am holding on all the others for a while.   Is this ok

 

Zyprexa 

[Altostrata]

What is your current drug schedule? How did your symptoms change when you divided the Ativan dose? When did you do this? Please update your signature.

[Worthy]

My current drug schedule is

Olanzapine .85 mg

Mirtazapine 3.2 mg

Cymbalta 13.5 mg

Ativan 1mg

My symptoms have not changed since i started taking ativan twice daily.  I don't know how to update my signature.  Not doing well.

 

 

 

[Altostrata]

14 hours ago, Worthy said:

My current drug schedule is

Olanzapine .85 mg

Mirtazapine 3.2 mg

Cymbalta 13.5 mg

Ativan 1mg

My symptoms have not changed since i started taking ativan twice daily.  I don't know how to update my signature.  Not doing well.

 

 

What times of day do you take each of these drugs, with their dosages? Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right.

 

How have your symptoms changed? Please be more forthcoming in your answers to my questions so I don't have to ask them again.

[Worthy]

Thanks for your message.  I take the olanzapine, mirtazapine at 10pm each night at the doses mentioned above.  I take the cymbalta each morning at 7am.  I am now taking the Ativan at 8am and 8pm @ .5mg eachntime.   My symptoms vary so,much day to ,day.   Some days I am barely able to,function and other days i am absolutely fine so,it is difficult for me to do a 24 hour timeline. I am also not sure how to update my signature.  I do feel a bit more in control now I have split my Ativan to twice a day.   I am continuing to taper the zyprexa at 3% every two weeks but currently holding on the others.   I hope I have answered your questions properly.  Should I just continue to taper the zyprexa as I am.  It is getting very difficult to weigh them and unfortunately where I live there are no compounding pharmacies.  I would like to know how low I have to go on the zyprexa before I can stop.  I do appreciate your invaluable help and advice.mm

 

[Altostrata]

4 hours ago, Worthy said:

I am now taking the Ativan at 8am and 8pm @ .5mg eachntime.

 

When did you start taking Ativan on this schedule? How have your symptoms changed since you started taking Ativan doses 12 hours apart?

 

Please read these topics:

 

Tips for tapering off olanzapine (Zyprexa)

 

Tips for tapering off Remeron (mirtazapine)

 

Tips for tapering off Cymbalta (duloxetine)

[Worthy]

Many thanks for your reply.  Would you consider .9 mg a safe dose to stop the zyprexa.