Kdot: Which do you prefer? Simple Taper, Reduced Potency Approach or the Half-life Approach?

[Kdot]

Hi all, first post here. 

 

I'm an amitriptyline taker originally for tension headache at 50 mg. 

I quit cold turkey after 9 months without knowledge of withdrawal, went back on for 9 months to re-balance. 

I've been reducing by 5 mg per month for 1 year until I got down to 15 mg.

I'm now reducing by 1 mg monthly as withdrawals since getting down to 15 mg have had a bigger impact on my mental health. 

 

I've been reading about the possible methods of withdrawal and am wondering if anyone has had more success from a simple taper, reduced potency or half-life approach?

 

More information here: https://www.mentalhealthexcellence.org/wp-content/uploads/2013/08/RxISK-Guide-to-Stopping-Antidepressants.pdf

 

Any input welcome! 

 

Thank you. 

Edited January 29, 2020 by manymoretodays
moved to introductions from S and S care

[Gridley]

Welcome to SA, Kdot.

 

Dropping 1mg a month sounds like a nice slow taper, and if you were on a much higher dose it would work well.  15mg is just above the top of the most sensitive part of the taper. Something like 85% of the drugs effectiveness happens in the first 10 mg, so making even a small change can have a big effect symptom-wise. Decreasing by a straight 1mg also accelerates the amount that you  would be decreasing each time making it rougher and rougher with each drop. Decreasing by a percentage however decelerates the amount of each drop and makes things gentler on your system.

 

We recommend a simple percentage taper of no more than 10% of current dose every four weeks.

 

Why taper by 10% of my dosage?

 

The Brassmonkey Slide, which is an alternative percentage method that we also recommend.  It is a way of making micro-taper reductions weekly, as opposed to a larger reduction once a month. 

 

The Brassmonkey Slide Method of Micro-tapering

 

This link is specifically about tapering Amitriptyline.

 

Tips for tapering off amitriptyline

 

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 way here.

 

 

 

 

[Kdot]

Hi Gridley, 

 

Thank you for such a detailed response. 

 

You said that 15mg is just above the top of the most sensitive part of the taper and that 85% of the drugs effectiveness happens in the first 10 mg... Does that mean that as I reduce from now I'm likely to experience stronger withdrawal symptoms?

 

I've been looking through your site for a while and was going to reduce by 1mg monthly until I get to 10mg as this would be less than 10% of the current dose, then start reducing by 10% at each drop from 10mg onwards. Does this sound okay?

 

Thanks for the link to the Brass Monkey Slide Method, I'm going to use this going forward.

 

I take fish oil daily and magnesium and zinc at night to help me sleep. I also take milk thistle, vitamin A, C & K, l-theanine and a occasionally a B-vitamin complex as I've read that amitriptyline can deplete B-vitamins, Coq10 and have anticholinergic effects. I wonder if you have any thoughts on this?

 

 

[Gridley]

2 hours ago, Kdot said:

Does that mean that as I reduce from now I'm likely to experience stronger withdrawal symptoms?

Not if you go slowly enough.  Going slowly at the lower dose will lessen the chance of increased withdrawal symptoms.  This link explains why.

 

Why taper paper: dose-occupancy curves

 

2 hours ago, Kdot said:

1mg monthly until I get to 10mg as this would be less than 10% of the current dose, then start reducing by 10% at each drop from 10mg onwards. Does this sound okay?

 

That's fine as long as the 1mg per month is below 10% per month.

 

2 hours ago, Kdot said:

B-vitamin complex as I've read that amitriptyline can deplete B-vitamins,

 

B vitamins can be overstimulating in withdrawal, which is why we don't recommend them.

 

Hypersensitive to B Vitamin or B-Complex  

 

 

 

 

[Kdot]

Thanks again for all the info. So disappointed to see that withdrawal could take me another 5 years. Still, I'm thankful for sites like this. Thank you for your help. 

[Gridley]

5 minutes ago, Kdot said:

So disappointed to see that withdrawal could take me another 5 years.

Yes, it does take a frustratingly long time.  I'm 3 years into tapering off 20mg Lexapro and have close to another year  before I'm ready to jump to zero.  But this is the safest and shortest route to take, since you avoid tapering too fast and having to updose then waiting to stabilize before you can begin tapering again.

 

The way to calculate how long is a simple formula.  Let's skip to the point when you're at 10mg and are starting your 10% taper.  You will reduce by half every six months.  So in 6 months you'll be at 5mg.  Another 6 months you'll be at 2.5mg., another 6  months 1.25, another .62, etc.  

[Kdot]

How has your withdrawal been?

 

It's so disheartening. We're trapped. I wish I could put my doc on this stuff to give him first hand experience of what I'm going through! Then perhaps he wouldn't prescribe it so readily. 

 

Thanks, I've used the calculator on one of the pages. The first 6 months sounds pretty great! Then there's another 6 months... And another... And another...!

[Gridley]

55 minutes ago, Kdot said:

How has your withdrawal been?

Not too bad, or maybe I should say tolerably bad, and of course long. I'm functional. I'm better than I was 6 months ago and that was better than a year ago.  The improvement is very very gradual.   I've had a lot of the typical symptoms.  Low-level tinnitus.  Muscle pain.  The insomnia has improved lately, whether because my Lexapro dose is getting low or because I've found the right dose of melatonin for me or a combination.  The anxiety has improved also as I've gotten to the low doses. Some symptoms like stiff neck go away, come back, go away. I hit a bad spell around the 3mg mark but that resolved as I got lower in dose.  Probably the anhedonia and apathy are the worst; I'm told they eventually lift.  I dropped to 0.8 Lexapro today and we'll see how low I can measure on the Gemini scale before switching to eyeballing it.  I'd like to get to 0.05 before jumping to zero.  The amount of powder in he capsule now is minuscule.

 

Then I'll wait about 3 months and start my Ativan taper.

 

Yes, the doctors have no idea.  The U.K. is a bit ahead of the U.S. is realizing the dangers of these terrible drugs.  The psychiatric guidelines in the U.K. were recently revised to admit the reality of severe and prolonged antidepressant withdrawal effects.

 

If you haven't read it, I recommend Anatomy of an Epidemic by Robert Whitaker.  A real eye-opener about the pharmaceutical industry and the bad long-term outcomes of psychiatric drugs.

 

 

 

[Kdot]

Does it feel like a waste of your life while you're coming off them? I know we're working towards something but it feels like while I'm doing this I'm stagnating and not progressing my life to the extent I would otherwise be. Any bursts of motivation are quickly overtaken by apathy. It makes me so angry. Or maybe I'm just extra angry today because I'm going through a bad patch.

 

It's good to hear that you're gradually improving as you get to the lower doses. Have you considered water titration for the last drop, to get it as low as possible?

 

When have you heard the anhedonia and apathy lift?! If you don't mind me asking, how many medications were you on and what were they for?

 

I'm tempted to try to sue my doctor for putting me on this medication! I shouldn't have been on it for tension headaches, he didn't tell me it was an antidepressant at higher doses, he told me to keep increasing the dose if it stopped working at any point and he didn't warn how to come off of it. I know it's partly/largely my responsibility but I trusted the professional. Never again!  I doubt I can sue anyway, it's not as common to sue people here as it is in America!

 

Thanks for the book recommendation. A quick search leaves me reeling in the mood I'm in today. Definitely looks worth a read when I'm in a calmer state! 

[Gridley]

7 minutes ago, Kdot said:

Does it feel like a waste of your life while you're coming off them?

 

I've pretty much accepted the situation.  This is my "job" now.  That's the way I've trained myself to look at it.  Of course, I'm envious of the undrugged people all around me and would like to enjoy life and be motivated.  It's just not happening right now.

Every morning I tell myself three things:   Make the best of it; be here now, and go with God.  

 

Regarding water titration, I'm done well with the tablet and don't want to rock the boat with a change to liquid.  Some do well with a switch to liquid, some don't.

 

I don't want to give you bad information, but I think I recall reading that anhedonia and apathy can be among the last symptoms to go.  Of course, that may very according to the individual.  We went to the city in Ecuador where we used to live last weekend and I actually had a pretty decent time plus some good food.  And I don't feel too bad right now.  So the anhedonia may be lifting a bit.

 

My medications are in my signature bu I'm happy to expand.  I was put on Imipramine (a tricyclic antidepressant) back in 1986 as an off-label usage for pain and inflammation for ulcerative colitis.  I hit a patch of career problems resulting in situational depression in the early 2000's and they tried me on Prozac, Zoloft, Effexor (nasty one, that) then finally Lexapro, which seemed to help or at least numbed me out sufficiently (it's the strongest antidepressant).  The Ativan I took for sleep and soon became dependent.

 

 

 

 

[lxjuice]

From a pharmacokinetics perspective I'm not sure about the potency approach. They are not so potent that 10% tapering or micro-tapering is difficult - it seems the actual reason people have trouble making small doses is because of precisely how small they need to be due to the short half-lives. Fluoxetine is about as potent as paroxetine, thought to be the easiest SRI by far to come off of and nobody complains that they can't dose it small enough. If you look at antipsychotics the difficulty coming off them definitely seems to be linked to half life rather than potency (i.e. quetiapine). I'm also not sure you could switch from amitriptyline to anything else because the TCAs are all quite different from each other and other antidepressants. You don't know the withdrawal is coming from SERT. I imagine you would have to cross-taper, and very slowly. Other users will have more insight on this.

[Kdot]

On 1/30/2020 at 5:23 PM, Gridley said:

 

I've pretty much accepted the situation.  This is my "job" now.  That's the way I've trained myself to look at it.  Of course, I'm envious of the undrugged people all around me and would like to enjoy life and be motivated.  It's just not happening right now.

Every morning I tell myself three things:   Make the best of it; be here now, and go with God.  

 

Regarding water titration, I'm done well with the tablet and don't want to rock the boat with a change to liquid.  Some do well with a switch to liquid, some don't.

 

I don't want to give you bad information, but I think I recall reading that anhedonia and apathy can be among the last symptoms to go.  Of course, that may very according to the individual.  We went to the city in Ecuador where we used to live last weekend and I actually had a pretty decent time plus some good food.  And I don't feel too bad right now.  So the anhedonia may be lifting a bit.

 

My medications are in my signature bu I'm happy to expand.  I was put on Imipramine (a tricyclic antidepressant) back in 1986 as an off-label usage for pain and inflammation for ulcerative colitis.  I hit a patch of career problems resulting in situational depression in the early 2000's and they tried me on Prozac, Zoloft, Effexor (nasty one, that) then finally Lexapro, which seemed to help or at least numbed me out sufficiently (it's the strongest antidepressant).  The Ativan I took for sleep and soon became dependent.

 

 

 

 

 

It almost feels to me like the withdrawal has become a disease in itself! I guess at least it's something we can do something about and are doing the best we can. 

 

That's interesting about the liquid... I'm currently on part tablet part liquid and wonder if the change has affected me too. 

 

A trip to Ecuador sounds pretty great! I was supposed to be there a couple years ago when I was travelling around South America but I ran out of funds!  I'm glad to hear it's picked you up a bit. 

 

Sorry, didn't check your signature. What a long, tough journey you seem to have had! It's great to hear you're still motivated to get yourself off of these horrible things. 

[Kdot]

On 1/30/2020 at 6:10 PM, lxjuice said:

From a pharmacokinetics perspective I'm not sure about the potency approach. They are not so potent that 10% tapering or micro-tapering is difficult - it seems the actual reason people have trouble making small doses is because of precisely how small they need to be due to the short half-lives. Fluoxetine is about as potent as paroxetine, thought to be the easiest SRI by far to come off of and nobody complains that they can't dose it small enough. If you look at antipsychotics the difficulty coming off them definitely seems to be linked to half life rather than potency (i.e. quetiapine). I'm also not sure you could switch from amitriptyline to anything else because the TCAs are all quite different from each other and other antidepressants. You don't know the withdrawal is coming from SERT. I imagine you would have to cross-taper, and very slowly. Other users will have more insight on this.

 

Thanks for the reply lxjuice. 

 

So what you've said backs up the longer half-life approach... I know amitriptyline converts to nortriptyline in the body and nortriptyline has a longer half-life than amitriptyline, but only by about 6 hours. 

 

Which did you mean is thought to be the easiest SRI to come off? Fluxotene or Paroxetine? I compared the half-lives of these 2 and seen that Fluxotene's half-life is much longer at 3 days so I assume that's the easier one to withdraw from, going by the half-life logic?

[lxjuice]

11 hours ago, Kdot said:

 

Thanks for the reply lxjuice. 

 

So what you've said backs up the longer half-life approach... I know amitriptyline converts to nortriptyline in the body and nortriptyline has a longer half-life than amitriptyline, but only by about 6 hours. 

 

Which did you mean is thought to be the easiest SRI to come off? Fluxotene or Paroxetine? I compared the half-lives of these 2 and seen that Fluxotene's half-life is much longer at 3 days so I assume that's the easier one to withdraw from, going by the half-life logic?

Yeah that's what I meant, fluoxetine is considered the easiest SRI to come off.

[Kdot]

Hello from England...

 

Do you have any information on emotional blunting as you withdraw?

 

I've become numb over the last few weeks after reducing from 13 MG to 12 MG so after waiting 7 weeks I've gone back up to 12.5 MG but I still feel numb and distant from everything, pretty emotionless. 

 

I'm wondering if this is part of the withdrawal process for most people, if it's because the drug affects you differently at a lower dose or if it's just what sometimes happens after taking a drug for a while?

 

And then ultimately, I'm looking for guidance on what to do about it... Some places say to reduce the dose but I don't think that will end well... 

[Gridley]

6 minutes ago, Kdot said:

 

I'm wondering if this is part of the withdrawal process for most people,

 

Vey, very common.  Although the drugs deaden the emotions when you're on them, withdrawal can deaden them further.  That has definitely been my experience.  While on the drugs, I had some feelings.  Now, while tapering, I have a lot of emotional  bluntness.

 

So, yes, it is a common part of the withdrawal process.

 

There is nothing you can do about it except proceed with a slow taper.  Increasing the rate of your taper to try to "fix" this will not end well.  This is just part of the process.

[Kdot]

Wow. I was afraid you'd say that. That's ****. I can't feel like this for years. I can't make any life decisions because I have no emotions to help me judge what's a good or bad choice. 

 

I'm wondering about changing to another drug with a longer half life to help me withdraw, do you have any thoughts on this?

 

[RhondaF]

 

Gridley, have you ever known anyone to get off these AD without any withdrawals?