Estman: reducing Anafranil, withdrawal symptoms

[Estman]

On 8/2/2021 at 12:06 PM, Shep said:

 

I'm not sure you can check the strength of the pills, although you may want to reach out to your local pharmacist. Usually going a few weeks past an expiration date isn't a problem for tablets or powder (for liquid it's more important). But for an expiration date of 2 months for packages dated October 2020, that would mean you're now 8 months passed the December expiration. 

 

When you get your next set of packages, you may want to gradually transition to the new powder in case there is a change in strength. You could crossover to the new powder by 25% increments every few days to allow your nervous system to adjust. 

Hi Shep,

After another reduction of Anafranil (7-8%), gastrogenic problems return. (3-4 days)
There is concomitant diarrhea, nausea and flatulence and restlessness
When I told my doctor about it, he advised me to try a small dose of 50 mg of sulpride

I was prescribed Olanzapine a few years ago and took it for a few months.
There was a terrible akathisia, insomnia suddenly very extreme and no confusion at all
Do I understand that sulpride is a neuroleptic and can also cause akathisia?
Currently I can sleep, although the sleep is very lively and confused
Does sulpride cause addiction like other psychiatric drugs?
Maybe it would be wiser to stay away from it?

[Shep]

On 8/1/2021 at 9:47 AM, Estman said:

The pharmacy has set the shelf life of the powder at 2 months.
I looked to have the packages made in October 2020

 

3 hours ago, Estman said:

After another reduction of Anafranil (7-8%), gastrogenic problems return.

 

Was this with the expired powder? If so, it may be due to using expired medication, in addition to symptoms caused by reducing the dose. 

 

You may want to updose a small amount to see if that helps. Please update your signature to reflect your decreases. How much you should updose will depend on when you decreased. Here is a direct link to your signature:

 

Account Setting - Create or Update Your Signature

 

3 hours ago, Estman said:

Does sulpride cause addiction like other psychiatric drugs?
Maybe it would be wiser to stay away from it?

 

Yes, it's wise to stay away from it. Sulpride is an antipsychotic (neuroleptic) that is just like any other psychiatric drug - it doesn't treat anything and it causes dependency. It can cause akathisia and all sorts of other problems. 

 

The best way to lessen the chances of withdrawal symptoms is to do a very slow taper and go into long holds when needed. Going on another psychiatric drug just continues the merry-go-round of drug dependency. 

[Estman]

2 hours ago, Shep said:

 

 

 

 

Yes, it's wise to stay away from it. Sulpride is an antipsychotic (neuroleptic) that is just like any other psychiatric drug - it doesn't treat anything and it causes dependency. It can cause akathisia and all sorts of other problems. 

 

The best way to lessen the chances of withdrawal symptoms is to do a very slow taper and go into long holds when needed. Going on another psychiatric drug just continues the merry-go-round of drug dependency. 

Yes, I'm moving slower and waiting for the symptoms to go away again.
The temptation to wean is to take another drug
Fortunately, I have experience with olanzapine and I do not want to experience hell of akathisia and insomnia again.
I am very grateful that you can listen to the experiences of others in this forum!

I read a study that wrote that most serotonin is produced in the digestive tract
However, reducing the dose causes changes in the beneficial bacteria that produce serotonin
I wonder if it would be possible to use propiotics to help the gastric microflora recover faster?

[Shep]

On 8/21/2021 at 10:03 AM, Estman said:

I wonder if it would be possible to use propiotics to help the gastric microflora recover faster?

 

Some people do find probiotics helpful, but it's very individual. Here is more information:

 

Probiotics and gut health

[Estman]

On 8/22/2021 at 8:06 PM, Shep said:

 

Some people do find probiotics helpful, but it's very individual. Here is more information:

 

Probiotics and gut health

Hi Shep,

Probiotics didn't help me much

I reduced my daily dose by 7-8% 7 days ago.
The last nights are completely out of place, I wake up several times a night with nightmares
Dreams are very lively, confusing, painful and abstract
Did you experience that too?
Another disturbing thing is the daily fluctuation
I'll take my dose at 4 p.m.
If at 2 pm it is more or less tolerable then an hour later it is always very bad, there is nausea, feeling unwell, tiredness
Even if I do nothing, there is always a change at that time.
It is very bad for several hours after taking the medicine at 4 pm and it is usually more or less better by 9 pm
Then the fatigue is gone and it is difficult to fall asleep

[Estman]

On 9/22/2021 at 10:13 PM, Altostrata said:

 

How long does this reaction last? When did this reaction first appear?

 

It indicates you are taking too much clomipramine.

If I have achieved stability (WN) with clomipramine, for some reason it is worse a few hours after taking a dose.
But, for example, I reduced my dose by 9% 6 days ago and now it is stably bad all day
Severe restlessness and agitation began yesterday at 5 days
Sleep also went very bad yesterday
Strange that only 5 days ago was more or less normal and now a constant nasty irritation in the head

[Altostrata]

Perhaps you should updose by 4% to address those withdrawal symptoms.

[Estman]

18 hours ago, Altostrata said:

Perhaps you should updose by 4% to address those withdrawal symptoms.

Hi Alto,

Should the percentage reduction of the dose be the same to the end?
Is there a therapeutic dose at some point and will it get easier after that?
Is the occupancy of receptors at a lower dose in line with the percentage reduction?

[Altostrata]

Do you remember Tips for tapering off clomipramine (Anafranil)

 

We are looking to taper drugs with minimal withdrawal symptoms. "Therapeutic dose" does not apply, we're not looking to treat "depression" or whatever.

 

Please put questions about your taper in your Intro topic, thank you.

 

[Estman]

17 hours ago, Altostrata said:

Do you remember Tips for tapering off clomipramine (Anafranil)

 

We are looking to taper drugs with minimal withdrawal symptoms. "Therapeutic dose" does not apply, we're not looking to treat "depression" or whatever.

 

Please put questions about your taper in your Intro topic, thank you.

 

8 days since the last cut today
For 2-3 days extreme symptoms
I am amazed every time a small change (in this case 8-8%) is so severe
The daily dose is currently 19mg
Last night was very extreme, I woke up 4-5 times.
Sleep very confused and scary and depressed
I usually get to do a moderate job, practically not at the moment
There is a feeling of great pressure in the head and especially in the neck, the head is completely dizzy and would be confusing
How in practice, is a fixed percentage reduction always made or is it reduced towards the end?
If withdrawal symptoms usually start in 2-3 days, have all the effects been achieved by now (8 days)?
All the more serious symptoms have probably come out
I have a red patch or rash under my armpit
Another symptom.
Did you still experience severe withdrawal symptoms after each dose adjustment? Did you reduce yourself by about 10% a month or less, how was tolerability?

[Estman]

At the moment there is great anxiety which has caused a high blood pressure of 160/105 and with it a very bad feeling .There is also nausea and headaches, especially in the neck
I took 1 tablet of Micardis and 0.5 tablets of Betaloc to lower my blood pressure
To some extent, blood pressure has been lowered, but extreme anxiety still fuels headaches and nausea.
I have diazepam but I haven't taken it in a long time
I don't know what to do.
Last time I also reduced the same percentage but it was not such a severe reaction.
The family doctor thought it was just a psychological reaction to the reduction
But I do not think so, there is also a great fear that it will not stabilize

[Altostrata]

As described in Tips for tapering off clomipramine (Anafranil) and other topics in the tapering forum, the reduction percentage (10% is suggested) is calculated on the *last* dosage you've taken, not your starting dosage (75mg).

 

The *amount* of the reduction keeps getting smaller, the percentage stays the same.

 

If you reduced from 35mg to 27mg, your rate of reduction is 23% (8/35), not 8%. An 8% reduction from 35mg would be 32.2mg.

You have been tapering much too fast, based on the wrong math.

 

You might updose to 20mg, see if that helps. I would not plan to reduce again for perhaps several months. Please let us know how you're doing.

[ChessieCat]

There are 2 graphs at the bottom of Post #1 of this topic which shows the difference in the two reduction types, called hyperbolic (current dose) and linear (starting dose).

 

why-taper-by-10-of-my-dosage

 

[Estman]

3 hours ago, Altostrata said:

As described in Tips for tapering off clomipramine (Anafranil) and other topics in the tapering forum, the reduction percentage (10% is suggested) is calculated on the *last* dosage you've taken, not your starting dosage (75mg).

 

The *amount* of the reduction keeps getting smaller, the percentage stays the same.

 

If you reduced from 35mg to 27mg, your rate of reduction is 23% (8/35), not 8%. An 8% reduction from 35mg would be 32.2mg.

You have been tapering much too fast, based on the wrong math.

 

You might updose to 20mg, see if that helps. I would not plan to reduce again for perhaps several months. Please let us know how you're doing.

I'm sorry my English is poor, I'm having communication problems.
I was on 17.05.20 at a 35mm dose
Each time I have reduced a small amount, a maximum of 8%
On 01.01.21 I had reached a dose of 27mg
35mg I reduced 27mg not once but 6-7 times
The biggest reduction I have tried in two years was 10% and it was too painful

[Estman]

15 hours ago, ChessieCat said:

There are 2 graphs at the bottom of Post #1 of this topic which shows the difference in the two reduction types, called hyperbolic (current dose) and linear (starting dose).

 

why-taper-by-10-of-my-dosage

 

Can you specify where I can find these charts?

I can't find them

I told the family doctor I was weaning Anafranil
I talked about having problems with all kinds of symptoms.
I can't handle a situation where my blood pressure is high
Usually it is within the norm but with great anxiety it gets high
Then there is a very big headache and nausea at all
The doctor thought it was a psychological thing
That if I know that I reduce the dose of the drug, then the symptoms occur psychologically
I tried to explain that I can't imagine everything and there are also physical bad symptoms such as nausea, weakness, fatigue
Withdrawal symptoms are not just psychological, even if I reduce them by only 5%
What do you think about that?
I have a feeling that if I try to take a medicine for blood pressure it will cause nausea and stomach upset.

[Altostrata]

18 hours ago, Altostrata said:

If you reduced from 35mg to 27mg, your rate of reduction is 23% (8/35), not 8%. An 8% reduction from 35mg would be 32.2mg.

 

You just made a reduction of 23%, not 8%, and got withdrawal symptoms.

 

I am confused about your tapering method. The exponential reductions we recommend should be calculated on your last dosage. It appears your calculations have been incorrect. You have been calculating on your starting dosage, resulting in linear reductions.

 

If I were you, I would updose to 30mg and not make any more drug changes for at least 2 months. Please let us know how you're doing.

[Estman]

10 hours ago, Altostrata said:

 

You just made a reduction of 23%, not 8%, and got withdrawal symptoms.

 

I am confused about your tapering method. The exponential reductions we recommend should be calculated on your last dosage. It appears your calculations have been incorrect. You have been calculating on your starting dosage, resulting in linear reductions.

 

If I were you, I would updose to 30mg and not make any more drug changes for at least 2 months. Please let us know how you're doing.

The calculation is still correct, each time I cut the remaining dose
If the daily dose was 25mg then I cut 2mg at a time and kept for 35 days
The next time was 23mg and I cut to 1.5mg at a time (daily dose 21.5mg) I kept for 57 days.
7-8% cut seems to be too much with Anafranil (for me)

[Carmie]

Hi Estman, 

 

Hope you’re doing okay. So you’re saying that you went from 35mg in May 2020 to 27mg in January 2021.  You didn’t do it all in one go, but you did about 7 cuts or so of around 8% or less. 
 

I can’t cut by 8% myself, it’s way too much for me. I always cut under 5%. You just have to keep seeing what works for your body. Remember too, that the holds are just as important as the cuts. Sometimes our holds have to be really long for our brains to reach some kind of equilibrium again, and then we can do the next cut.
 

Sending hugs🤗

[Estman]

4 hours ago, Carmie said:

Hi Estman, 

 

Hope you’re doing okay. So you’re saying that you went from 35mg in May 2020 to 27mg in January 2021.  You didn’t do it all in one go, but you did about 7 cuts or so of around 8% or less. 
 

I can’t cut by 8% myself, it’s way too much for me. I always cut under 5%. You just have to keep seeing what works for your body. Remember too, that the holds are just as important as the cuts. Sometimes our holds have to be really long for our brains to reach some kind of equilibrium again, and then we can do the next cut.
 

Sending hugs🤗

Hi Carmie,

Yes, you are right
I have never cut more than 8-9% at a time
But as you mention it too much
The desire is very much to get rid of this disgusting Anafranil, but with great torment every time
I had the last cut 10 days ago and it is 8-8.3%
A few days ago there was total anxiety and high blood pressure
I took some blood pressure drugs
Blood pressure is now more or less but for the second day it is severe depression
Along with that, there is despair 
I'm a freelancer and luckily I don't have to go anywhere to work, I can't do that
I work from home.
I really like my job, but I can't enjoy it during the wave
At the moment I can work a few hours
The family doctor said that it is psychological that if such a small dose I reduce
When there is no depression at the moment, it is a very disgusting feeling with nausea.
Doctors do not believe that such severe symptoms will occur
I rcut Anafranil  only when it has stabilized, usually once a month
10 days ago it was more or less normal, now complete chaos
There was a lot of agitation last night although I was calm and there was no anxiety
There were also strong compulsions and pressure in the head.
Yes, I guess I have to cut 5%, not more.
Fortunately, this community is here that supports each other. 
 

the best!

[Estman]

4 hours ago, Carmie said:

Hi Estman, 

 

Hope you’re doing okay. So you’re saying that you went from 35mg in May 2020 to 27mg in January 2021.  You didn’t do it all in one go, but you did about 7 cuts or so of around 8% or less. 
 

I can’t cut by 8% myself, it’s way too much for me. I always cut under 5%. You just have to keep seeing what works for your body. Remember too, that the holds are just as important as the cuts. Sometimes our holds have to be really long for our brains to reach some kind of equilibrium again, and then we can do the next cut.
 

Sending hugs🤗

If you cut about 5%, how long did you usually stick to the new dose?

[Altostrata]

What exactly were your last 3 reductions, and when did your withdrawal symptoms start to ramp up?

 

We're very clear that if you find you get withdrawal symptoms from your tapering rate, which in your case might be ~8% per month, to reduce the rate of taper. This has never been a secret. You have to negotiate your rate of taper with your own nervous system, not with anyone on this site.

[Carmie]

8 hours ago, Estman said:

If you cut about 5%, how long did you usually stick to the new dose?

Hi Estman, 

 

Hope you’re having a good day. As regards tapering, as I mentioned, you have to figure out what taper rate works for you. Everyone is different. 
 

I do under 5% every three months or so. I taper in different ways to get this percentage.
 

Sometimes I’ve just cut by 5% or under and held for about three months.
 

I’ve also cut that percentage in half and tapered over 2% and held that for six weeks and then tapered the other half and held that for six weeks. It still came to around 5% in three months. 
 

This time I’m tapering in even smaller amounts but arriving at at the same destination. I started at 4.20mg and I dropped down to 4.15mg. I’ll hold that for three weeks, then I’ll drop to 4.10mg and hold for three weeks, then 4.05, then 4mg. 
 

So this time it’s 4 drops of over 1% every three weeks and I still end up at around 5% at the end of three months. The smaller drops are a little easier on the brain. 
 

Even though you’re not doing well with 8 or 9% drops, you might not have to go as low as I’m going, but maybe just a bit lower than you are at this time. You’ll just have to experiment and see. But if you’re going through waves now, please don’t taper until they settle as you’ll make it worse. Make sure you stabilise first. 
 

Again, with the holds too, you might not have to hold as long as I am, but make sure to have long holds. If they are not long enough a few drops in a row can all of a sudden catch up with you and you can go into major waves. They’re accumulative. 
 

Sending hugs🤗

[Estman]

12 hours ago, Carmie said:

Hi Estman, 

 

Hope you’re having a good day. As regards tapering, as I mentioned, you have to figure out what taper rate works for you. Everyone is different. 
 

I do under 5% every three months or so. I taper in different ways to get this percentage.
 

Sometimes I’ve just cut by 5% or under and held for about three months.
 

I’ve also cut that percentage in half and tapered over 2% and held that for six weeks and then tapered the other half and held that for six weeks. It still came to around 5% in three months. 
 

This time I’m tapering in even smaller amounts but arriving at at the same destination. I started at 4.20mg and I dropped down to 4.15mg. I’ll hold that for three weeks, then I’ll drop to 4.10mg and hold for three weeks, then 4.05, then 4mg. 
 

So this time it’s 4 drops of over 1% every three weeks and I still end up at around 5% at the end of three months. The smaller drops are a little easier on the brain. 
 

Even though you’re not doing well with 8 or 9% drops, you might not have to go as low as I’m going, but maybe just a bit lower than you are at this time. You’ll just have to experiment and see. But if you’re going through waves now, please don’t taper until they settle as you’ll make it worse. Make sure you stabilise first. 
 

Again, with the holds too, you might not have to hold as long as I am, but make sure to have long holds. If they are not long enough a few drops in a row can all of a sudden catch up with you and you can go into major waves. They’re accumulative. 
 

Sending hugs🤗

 

Hi Carmie,

I will try not to exceed 5% in the future
There is a pretty strong depression right now
I start my work in the morning and two hours later I am completely tired
Suddenly the mood and mood becomes very depressed and I don't want to do anything anymore
I call it chemical depression
You probably still have it after the dose is reduced?
Three months seems a bit too long for me to keep 1-1.5 months normal
but yes, it must stabilize before re-cutting
Hopefully it will get better again soon, at the moment in severe depression and at the same time abdominal pain-nausea

[Carmie]

19 hours ago, Estman said:

 

Hi Carmie,

I will try not to exceed 5% in the future
There is a pretty strong depression right now
I start my work in the morning and two hours later I am completely tired
Suddenly the mood and mood becomes very depressed and I don't want to do anything anymore
I call it chemical depression
You probably still have it after the dose is reduced?
Three months seems a bit too long for me to keep 1-1.5 months normal
but yes, it must stabilize before re-cutting
Hopefully it will get better again soon, at the moment in severe depression and at the same time abdominal pain-nausea

That sounds like a good plan Estman, and definitely hold until you stabilise again. If you don’t you’ll just end up making your waves longer and you won’t get to your destination any quicker. You’ll just suffer more. 
 

And, yes, we still get waves and any of the withdrawal symptoms whether we are tapering high or low doses.

 

Take care🤗

[Estman]

On 10/14/2021 at 8:28 PM, Altostrata said:

What exactly were your last 3 reductions, and when did your withdrawal symptoms start to ramp up?

 

We're very clear that if you find you get withdrawal symptoms from your tapering rate, which in your case might be ~8% per month, to reduce the rate of taper. This has never been a secret. You have to negotiate your rate of taper with your own nervous system, not with anyone on this site.

5.10              19mg (before 20.6mg) cut 8.5%
9.09            20.6mg (before 22.2mg) cut 8%
14.08          22.2mg (before 23.8mg) cut 7.5%
23.04         23.8mg (before 25.5mg) cut 7%

Since I take the powder and no aqueous solution is made, the accuracy is a bit lower

[Altostrata]

If your method is not working, please consider revising it.

[Estman]

On 10/16/2021 at 9:41 PM, Altostrata said:

If your method is not working, please consider revising it.

I am currently taking the full dose once a day at 4.30pm
The first half of the day is always better but always changes at 14-15 in the afternoon
Between 4 and 7 pm there is often a great deal of fatigue and a general bad mood, sometimes nausea
I can work up to 14 and then light work
I would understand if the work would be hard but not
I always have to sleep between 3pm and 4.30pm
Strange, at 14 feel still normal and an hour later there is a sudden fatigue. Hopefully it will ever end anyway?
Is it caused by a decrease in the dose of the medicine in the blood?
Doesn't it make sense to take it several times a day?
While there is great fatigue, the hands and feet are also weak
In addition, restlessness
Today is 23 days after the dose was cut

[Altostrata]

On 6/22/2020 at 12:11 PM, Altostrata said:

None of these questions can be answered until we see a daily symptom pattern. 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.

 

[Estman]

On 10/16/2021 at 7:48 AM, Carmie said:

That sounds like a good plan Estman, and definitely hold until you stabilise again. If you don’t you’ll just end up making your waves longer and you won’t get to your destination any quicker. You’ll just suffer more. 
 

And, yes, we still get waves and any of the withdrawal symptoms whether we are tapering high or low doses.

 

Take care🤗

Hi Carmie,

It's been 26 days since my last cut
The first 14 days were a very heavy wave
Then about a week I felt better
Now the last 5 days again a very excruciating wave
It started 5 days ago when my heart rate and blood pressure went high
waking up at night and also in the morning was an immediate racing pulse
I thought I was taking my blood pressure down and I took one tablet of Telmisartan in the morning. It was a completely crazy situation that night.
There was insane depression, a constant fight-escape reaction, a constant feeling of fever and nausea
I took another 1.5 tablets of Metoprolol, which should calm my heart rate.
Unfortunately, the following days were even worse.
I have a feeling that Telsmisartan blood pressure medicine worsens depression, maybe so does Metropolol?
Can it be so?
metropolis last night I had a good and deep sleep but when I wake up immediately there is a very strong depression and fatigue.
I have noticed that after a few days of fighting-escaping panic, there is always depression and great fatigue later.

[Estman]

On 2/7/2021 at 9:10 PM, Shep said:

@Estmanplease note I moved the above post out of Sleepless's intro thread, so you are asking about your own taper. 

 

 

Please see the below article for a very good explanation of the link between psychiatric drug withdrawal and fatigue. 

 

Protracted psych drug withdrawal syndrome, chronic illness, CFS, Fibromyalgia: it’s autonomic nervous system dysfunction

 

 

It seems to me that the blood pressure drug Termisaltan makes the wave heavier, causes even deeper depression and also increases anxiety and nausea.
Now that I have taken them for two days, there is more fatigue and also a bad mood.
Are there any posts or information on this topic?

[Carmie]

Hi Estman, 

 

I’m sorry you’re getting side effects from the blood pressure medications. I don’t know anything much about blood pressure medication. My blood pressure is the opposite, it’s really low. I’m faint all the time, I’m always having to sit and lie down. I can’t stand in one spot for any length of time.  
 

I do know that anything one takes can affect withdrawals, even supplements. I don’t do well with fish oil, so I eat lots of salmon and oily fish. 
 

One of the meds you mentioned is a beta blocker. There is a thread in self care on that. Just put beta blockers in the search section above and there will be different ones discussing them. I don’t have a computer, just my iPad, and I don’t know how to add links. 
 

Take care🤗

[PsychologicalSafe15]

@Estman HOw long did you had PE after stopping Anafranil ?

[Estman]

3 hours ago, PsychologicalSafe15 said:

@Estman HOw long did you had PE after stopping Anafranil ?

Hi,

 

Please repeat your question. What exactly do you mean?

[PsychologicalSafe15]

@Estman I see people complaining about early ejaculation after quitting Anafranil ? DId you notice that ? how long did it last ? 
 

[Estman]

4 minutes ago, PsychologicalSafe15 said:

@Estman I see people complaining about early ejaculation after quitting Anafranil ? DId you notice that ? how long did it last ? 
 

Anafranil has not been completely abandoned yet
Another year to go.
This symptom has not been observed

[PsychologicalSafe15]

Update us when you completely abandon that drug and how long does it take to regain back .

How old are you ?