dewdrops: Tapering Saphris (and then Anafranil)

[dewdrops]

Hi everyone

 

My apologies for such a long post. I didn't want to leave anything out.

 

I had been on the dose of Saphris 10mg at night for around 6 months and then last month, my psychiatrist gave me a plan to reduce and then cease the Saphris. She suggested Saphris first because she believes it’s probably more responsible for the fatigue and drugged feeling. I am concerned it won’t be a successful taper if I do it her way because it’s reducing by too much and too quickly from everything I've read online and in Dr Peter Breggin’s book Psychiatric Drug Withdrawal. My psychiatrist’s suggestion was to reduce to 5mg for 3-4 weeks and then decide if Saphris is helpful or not and then if I think it is, stay on 5-10mg and if I think it’s not helpful, then to cease it and monitor how I go and if I have problems go back to 5mg. My issue with this is that the idea of it having a “helpful” effect is not terribly accurate, as negative effects I might have from stopping would most likely be due to withdrawals because they never actually helped me when I started them in the first place. 

 

I've actually been on my tapering journey for about 13 months, but have reduced by more than the recommended 10%. I am currently taking Anafranil (Clomipramine) 50mg and Saphris (Asenapine) 7.5mg. I reduced Saphris to 5mg from 10mg as my doctor suggested on 28^th Dec 2019, but experienced flat mood, anxiety, irritability and generally not feeling secure. I read some posts on here and discovered some have split Saphris wafers (I previously wasn’t sure if this was OK to do and couldn’t find a straight answer online). I did split them the past 5 nights though, and took a dose of 7.5mg, and felt better within a couple of days. Unfortunately, Saphris is only available in 5 and 10mg wafers in Australia, so it will be harder to get smaller doses as I get lower.  The original dose of Saphris I was taking before starting the taper was 5mg in the morning and 15mg at night, I reduced this to 5mg in the morning and 10mg at night in around February 2019 and then to 10mg at night in around June 2019. I was pretty settled on just 10mg at night leading up to my most recent reduction (to 5mg, then back up to 7.5mg) – I had some slight headaches, jaw clenching and anxiety when I dropped the 5mg in the morning, but that only lasted about a week to 10 days.

 

I had been on higher doses of Clomipramine (as high as 200mg) but my blood serum levels were always too high (I think due to being on Thyroxine which I later discovered through my own research can cause this), so it was rapidly reduced by 25mg decrements to 100mg and then my first accidental reduction to 75mg when I was discharged from hospital in Nov 2018 and thought that was my prescribed dose. I had no ill effects reducing the Clomipramine to 50mg a month ago, or any of the other times before. I think, in general, the clomipramine has a milder effect on my brain than the Saphris and will be easier to reduce for that reason. I actually haven’t had my levels checked since I was on 125mg, but they were high at that time. 

 

So far, with the clomipramine, I have been tapering by the whole 25mg tablets (which are tiny and will not fit in a pill cutter). I haven’t had issues reducing them, I didn’t experience any adverse withdrawal effect with any of the reductions thus far – however, I am aware that will be more likely once I get lower and lower and so, I want to reduce it by smaller amounts. I believe I read that Anafranil in the US is a capsule? I am wondering why it is different here. I’m not confident splitting it myself, so I am going to contact my local compounding pharmacist and see if they can make something up when I am ready to taper it, if I can get a prescription from my psychiatrist.

 

I have also reduced and ceased prazosin (Minipress) from 6mg over the past year which I was on for nightmares. The nightmares have not returned, and I currently sleep well. 

 

I am really motivated to get off these drugs, I wish I had never been put on them; however, I also really want to do it safely and with the least negative impact on my wellbeing and health from withdrawals. I have so much fatigue, and I am currently 50-55kg overweight (and that’s after slowly releasing around 40kg over 2 years) which are both major motivators in tapering. I have some blood sugar issues and glucose intolerance. I have been on various psychiatric medications for 19 years, since I was 16. I hate to think of the damage these drugs have caused to my whole body, especially my brain. My biggest improvements have come from changing my lifestyle and working really hard in therapy and on self-inner work. The drugs I am on are not even approved for treatment of my diagnoses, as far as I am aware, and they’ve never helped with my symptoms except to sedate. 

 

I have also had ECT many times prior to 2016, which affected me so badly that I couldn’t form a sentence to hold a conversation. I have little doubt that it was some kind of brain damage. My poor brain has copped a terrible assault over the years and I hope to repair some of the damage. 

 

Thanks for reading. I will read more posts here and continue to try to gain as much knowledge as I can around how to successfully taper these drugs.  

 

dewdrops

[Gridley]

Welcome to SA, dewdrops.  I hope you're not being affected too badly by the fires.

 

Doctors invariably taper their patients off psychiatric drugs too fast.  We recommend tapering by no more than 10% of your current dose every four weeks. It is especially important to taper slowly at the lower doses.

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering asenepine, including how to obtain the small nonstandard doses you'll need for your taper.

 

Tips for tapering off asenapine (Saphris)

 

For future reference this link is about tapering clomipramine.

 

Tips for tapering off clomipramine (Anafranil)

 

Tapering too fast puts you at risk of withdrawal symptoms, which can be long-lasting.

 

What is withdrawal syndrome.

 

We also recommend tapering only one drug at a time.  Otherwise, if problems arise, you won't know the cause.  Generally, we recommend tapering the more activating drugs, known as accelerators, and saving the more sedating drugs, known as brakes later to act as a buffer.  Both your drugs are brakes.

 

Taking multiple psych drugs? Which drug to taper first?

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found your wy here.

[dewdrops]

 

Thank you for the warm welcome, Gridley and for the links. 
 

Thankfully, I am in a safe area from the fires, however sadly, I have family and friends under threat. It has been so devastating. It is heartening to see support from all over the world, though! 
 

I do take Omega 3 in the form of algae oil, which I didn’t mention in my post but did put in my signature. I also take a B12 supplement, and iron at the moment due to a few iron issues. I will look into a magnesium supplementation. 

 

I am now very much on board with a gradual 10% taper. After the few difficult days I experienced from halving the dose of Saphris at my doctors suggestion after Christmas, I am very aware that this needs to be done very slowly. I will be purchasing a good scale to do this properly. 
 

I have had difficult withdrawals in the past when a psychiatrist ceased three antipsychotics I was on (zeldox, abilify and zyprexa) in a matter of a few days. It is an experience I don’t even remember but my parents said it was horrific and I crashed badly. I don’t know why I was even on three antipsychotics at the same time, but she put me in further danger by having me go cold turkey. I don’t want to put myself in that kind of risk again.

 

Warmest,

,

dewdrops
 

 

[Hello20]

@dewdrops

Hi, are you still on Saphris or did you manage to get off?