Nivsch: what do you think about reducing 1mg every week

[Nivsch]

I take Duloxetine 60 mg and want (not alone of course but with my psychiatrist) to start reducing the dose by 1 mg every week.

 

I read the 10% method. but why not 1mg every week? seems to me more gradual. and during the last 10mg - only then - to do the 10% method.

 

What do you think?

[Gridley]

Welcome to SA, Nivsch.

 

We much prefer the 10% method for a couple of reasons.  First, using the 1mg a week method, once you get below 40mg, you'll be tapering by more than the 10% of current dose every four weeks that we recommend and that excess will increase as you get lower and lower.   

 

Second, decreasing by a straight 1mg a week accelerates the amount you would be decreasing each time, making it rougher and rougher with each drop.  By contrast, decreasing by a percentage decelerates the amount of each drop and makes things gentler on your system.

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering Duloxetine, including how to taper by reducing beads.

 

Tips for tapering off Cymbalta (duloxetine)

 

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.

 

 

 

 

[Altostrata]

Welcome, Nivsch.

 

If you want to reduce 60mg duloxetine by 1mg per week, that would be under our 10% per month guideline until you got to 40mg duloxetine.

 

You'll have to figure out how many duloxetine beads are in 1mg, probably by weighing. Please let us know how you're doing.

[Nivsch]

Nivsch

 

problem and the drug itself plays as fuel to the fire of the (relatively) bad emotional state, 

OR that the drug actually helps but just not enough?

 

Is there a scientific/objective way to know the answer?

 

I just want to add that these days I start a new diet with much more raw food (very close to 801010) and I know that If I will improve emotionally in the next months - It can be because of the diet, and I think that I won't be able to know if the tapering down of the drug dose (what i am planning to start in the mid of may) will take part in the improvement or not.

 

 

 

Edited May 6, 2020 by Gridley

[Nivsch]

@Gridley @Altostrata thank you very much. I will update my process here.

[Gridley]

 Nivsch, please do not start a new Introduction topic when you want to ask a question.  All of your posts about your situation should be posted in your original Introduction topic, which is here:

 

Nivsch  What do you think about reducing 1mg every week

 

 

54 minutes ago, Nivsch said:

 

problem and the drug itself plays as fuel to the fire of the (relatively) bad emotional state, 

OR that the drug actually helps but just not enough?

 

 

I'm sorry, but I don't understand your question.  

 

Regarding the benefits of psychiatric drugs, I would recommend the book, Anatomy of an Epidemic by Robert Whitaker.  He demonstrates that in the long term, people who didn't stay on psychiatric drugs, including antidepressants, did much better than those who did stay on them.

 

1 hour ago, Nivsch said:

that I won't be able to know if the tapering down of the drug dose (what i am planning to start in the mid of may) will take part in the improvement or not.

 

 

That is true.  

[Nivsch]

@Gridley 

My question is how can I know if the drug I taking (2010-2013 ssri, 2015-today snri) is part of my not-good-enough mental state I'm in, OR that the drug is helping me?

 

OK i will add next messages to the original one. no problem. I have read half of this book by now. In 'this is true' You mean that I will never know if the tapering down will be part of the improvement?

[Gridley]

5 hours ago, Nivsch said:

My question is how can I know if the drug I taking (2010-2013 ssri, 2015-today snri) is part of my not-good-enough mental state I'm in, OR that the drug is helping me?

The reason I mentioned Anatomy of an Epidemic is that over the long term drugs don't help. 

 

5 hours ago, Nivsch said:

In 'this is true' You mean that I will never know if the tapering down will be part of the improvement?

We recommend making only one change at a time.  Otherwise, you can't know what's causing an improvement or, for that matter, a problem.

Edited May 7, 2020 by Gridley

[Nivsch]

On 5/7/2020 at 4:22 PM, Gridley said:

We recommend making only one change at a time.  Otherwise, you can't know what's causing an improvement or, for that matter, a problem.

 

Have you heard about cases that improvement apear DURING gradual tapering?

 

How common it is?

[Gridley]

35 minutes ago, Nivsch said:

 

Have you heard about cases that improvement apear DURING gradual tapering?

Definitely.  It is common to experience improvement in how you feel as your drug dosage become lower.  There will be ups and downs but the trend will be toward improvement.  I feel better at my current low dosage than I did at higher doses at other points of my taper. 

[Nivsch]

30 minutes ago, Gridley said:

Definitely.  It is common to experience improvement in how you feel as your drug dosage become lower.  There will be ups and downs but the trend will be toward improvement.  I feel better at my current low dosage than I did at higher doses at other points of my taper. 

This is valid also to the last miligrams and even after the jump to 0?

I am asking because I want to know if there is a slot(s) of time when I can know that "the improvement now is most likely because of the diet/tapering" and be able to seperate the parameters roles in the improvement.

 

I can't wait 1-2 years to know the full potential of the diet and only then start tapering, I really dont have patience for that.

Also my digestive system is distrupted by the drug so I feel i have to do both (new diet + tapering) at the same time.

 

But i want to collect clues during the process about the relative weight of every parameter in the improvement and My aim in this message is to learn what are the "hot" time slots in them i can realize what parameter (tapering OR new diet) caused the improvement.

 

[Gridley]

2 minutes ago, Nivsch said:

This is valid also to the last miligrams and even after the jump to 0?

 

I have found it to be so at the low milligrams, though I had a rough spell around the 3mg mark that improved once I got lower.  It's common for people to have a tougher time at certain doses, but it's different for everyone where this will happen.  So that muddies the waters.

 

Regarding after the jump to zero, experiences vary.  Many have reported ups and downs even after a slow taper, with common points when waves occur being around the 3 and 9 month mark.  

 

 

[Nivsch]

On 5/7/2020 at 1:21 AM, Gridley said:

Regarding the benefits of psychiatric drugs, I would recommend the book, Anatomy of an Epidemic by Robert Whitaker.  He demonstrates that in the long term, people who didn't stay on psychiatric drugs, including antidepressants, did much better than those who did stay on them.

 

Question: Does the long-term improvement which refers to the quit from taking the drugs, also tend to happen (in lower strengh) even for every reduce of the dose?

 

[Gridley]

1 hour ago, Nivsch said:

 

Question: Does the long-term improvement which refers to the quit from taking the drugs, also tend to happen (in lower strengh) even for every reduce of the dose?

Yes.  Healing occurs when you begin to reduce the dosage and continues as you get lower and lower.  

[Nivsch]

On 7/4/2020 at 8:08 PM, Gridley said:

Yes.  Healing occurs when you begin to reduce the dosage and continues as you get lower and lower.  

Thanks

[Nivsch]

I have a question:

Is reducing 2.5% of the current dose every week without holds at all equal/more subtle/more rough than the 10% every 4 weeks method?

[DataGuy]

@Nivsch this would be slightly gentler, since you are reducing a bit less than 10% per month and it is a smaller reduction at any given time. 

 

It is less because you are reducing 1.5mg (2.5%) initially, but then you would be reducing 1.46mg (58.5mg x 2.5%) the next week, then a bit less the next time. By the one month mark, you would be at 54.22mg, rather than 54mg. So the taper is a bit slower and should be smoother too. However, if you find symptoms are getting too much, you can always taper more slowly. Best to keep yourself as functional as possible. Many do find they need to taper more slowly than this pace. 

 

This link provided by @Gridley explains why it is important to go slowly during the taper. It can be difficult to stabilize your nervous system if it gets frazzled by a too-fast-taper and symptom onset can be delayed, subtle, and a bit difficult to identify. Some have an easy time with a quick taper, but others have difficulty with even a very slow taper. You will find out when you start tapering, but best to begin conservatively. 

Edited July 9, 2020 by DataGuy

[Nivsch]

Can the brain adapt to the PHASE of tapering itself during the time?

 

I mean, if the brain can adjust itself to a specific dose (tolerance - reducing effectivness) or to any new dose over the time. Why won't it be that the brain has the ability to adjust also to the slope itself (of the reducing)?

 

Which means for example if I reduce 1.75% every week, in the beggining it will be relatively difficult but after couple of weeks and months it will be easier and easier. What do you think?

 

Edited July 21, 2020 by ChessieCat
added topic title

[ChessieCat]

Many members find that the lower their dose gets the slower they need to go, reducing less and/or holding longer.

 

Why taper paper: dose-occupancy curves

[brassmonkey]

Hi Nivsch-- Chessie sent you a link to what is called the SERT Occupancy chart.  This is the basis for the 10% every four weeks that we recommend as a starting point. By following this hyperbolic curve it is possible to remove the medication at about the same rate that the bodies receptors require to heal.  This keeps WD symptoms to a minimum during that period. If a person reduces too much or to fast there is unfinished healing that builds up in the background.  When that unfinished healing gets to be too much the person "crashes" with an outbreak of acute symptoms. This requires an extended hold period at that dose lever to allow the body to catch up.  

 

If a person goes slower than the recommended taper there is much less of a problem.  To a small extent the body can get ahead of the curve and do some healing before it is needed.  Once a taper has been established, on some cases, the body can anticipate the upcoming changes and get a head start on them. In effect becoming habituated to the idea of tapering and having some momentum in a downward direction. But it is a delicate balancing act to maintain as there are so many different factors involved in a smooth taper.

 

There are differing results for how easy a taper becomes over time. It is  split between the taper becoming easier and it becoming harder.  Because of the SERT Curve we can see that there is a bias toward it becoming harder. As you can see the lower the dose the move affect it has on the SERT loading so a small adjustment can lead to a large change. This is why we recommend people going slower and smaller changes toward the end of a taper. Frequently. if a person had fine tuned their taper, they will feel improvements the lower they go in dose.

[Nivsch]

@brassmonkey Given that the % reducing method (becomes smaller over time) is precisely established because of the SERT curve, it has to offset the exponential curve effect. So why there is still a bias towards becoming harder? 

 

And thanks a lot for the detailed answer.

[brassmonkey]

It's very hard to answer questions like this because even the people who make the drugs don't really understand how they work and how the body reacts to them. All we can report is from the observations we have made while helping many people taper off of these drugs. There are so many factors involve, taper rate, metabolic rate, external stress levels, drug interactions, to name a few, that it is impossible to nail it down to one specific thing.

[Nivsch]

I have a question about recovery.

 

Even after one finished all the tapering and were in zero for 1-2 years and his brain has fully recovered FROM THE DRUG.

 

How he expect to feel good and "healthy" if he didn't solve the root of his mental problem (traumas, toxins, nutrition etc.)?

 

It seems to me that it is very very easy to get confused, and think that after your brain will fully recover from the drug - you will be in "0" mood and healthy.

But its not true, because if in the first place you started using the drug because of mental health of "(-3)", and lets say today, after 5-10 years with the drug you are in (-7), why do you think you will be in "0" after your tapering? your will return to (-3) in the best case.

 

So if you have not worked on the root of your problem, all the tapering and recovery process from the drug will be extremely difficult, because the MAXIMUM you can reach to is (-3), so most of the recovery process you will be between (-5) and (-7) and from that point, there is no wonder at all why tapering is so difficult for so many people - not because of the tapering (partially) but MAINLY because your maximum potential level is still low!

[Altostrata]

Wherever you go, there you are. If you have longstanding 'mental health" or emotional problems from, for example, a childhood of neglect, you will have to learn to cope with or work through those problems.

 

If you have longstanding health issues, such as migraine or poor diet, you will still have to learn self-care to manage your symptoms or optimize your physical health.

 

If you were exposed to toxins, like mercury or lead (as in a factory, a mine, or lead paint), you will need to consult medical specialists to remove them from your body. This is only for real, serious exposure to toxins. We don't endorse liver purification or other detoxification procedures here.

Edited July 22, 2020 by Altostrata
clarification

[ChessieCat]

5 hours ago, Nivsch said:

I have a question about recovery.

 

Posts moved from Windows and Waves topic to member's introduction topic.

[Nivsch]

22 hours ago, Altostrata said:

Wherever you go, there you are. If you have longstanding 'mental health" or emotional problems from, for example, a childhood of neglect, you will have to learn to cope with or work through those problems.

 

If you have longstanding health issues, such as migraine or poor diet, you will still have to learn self-care to manage your symptoms or optimize your physical health.

 

If you were exposed to toxins, like mercury or lead (as in a factory, a mine, or lead paint), you will need to consult medical specialists to remove them from your body. This is only for real, serious exposure to toxins. We don't endorse liver purification or other detoxification procedures here.

👍

Thank you.

 

I have Another question:

I read right now again here in the forum about the SERT occupacy curve. It made me an impression that the first miligrams are almost nothing in terms of SERT occupacy.

I am on duloxetine with original dose before tapering that was on 60mg. Now I am already on 52 and I felt that the reducing from 54 to 52+ was difficult. Given that curve - can it be most likely that what i felt was *most likely* not at all from the reducing and in this initial stage, the effect of such a reducing is mostly psychological? Like nucebo effect.

Because if the answer is yes, maybe i can be more confident to keep reducing in this phase (2.5% per week) and not turn into 1%. because the curve says that in this stage the occupacy change is very tiny and most likely its all psychological right now (maybe...) What do you think?

[ChessieCat]

The SERT occupany curve is just a guideline.  The 10% reduction every 4 weeks is general rule to getting off psychiatric drugs.    Some people might be able to taper faster, whilst some need to go slower.  But nobody knows if they can go faster, unless they try it and find that they are okay.  But if they do try to go faster and things get worse, it can sensitise their nervous system and they can become destabilised and it may take a long time to stabilise again.  Some members find that they don't get back to how they were feeling before they tried to go faster.  The ones who need to go slower start to understand that they need to reduce their taper rate as they notice over several reductions that their withdrawal symptoms don't reduce in a short period of time.

 

There may be doses that you reduce to during your taper that you find that you have increased withdrawal symptoms compared to other reductions.  There may be some dose reductions that you make where you get very few or very mild withdrawal symptoms.  This will be different for different people and different drugs.  When this happens the best thing to do is to hold on the same dose until things stabilise, also known as WDnormal, before making another reduction.

[Altostrata]

3 hours ago, Nivsch said:

I felt that the reducing from 54 to 52+ was difficult. Given that curve - can it be most likely that what i felt was *most likely* not at all from the reducing and in this initial stage, the effect of such a reducing is mostly psychological? Like nucebo effect.

Because if the answer is yes, maybe i can be more confident to keep reducing in this phase (2.5% per week)

 

If you felt the decrease, you're going too fast. Tolerance for decreases is individual. Your nervous system has the final decision. Your personal occupancy curve might have a slightly different shape than the average, which is what's in the journal articles.

 

I see you started out as a 10% skeptic. The reason we urge you to do a hyperbolic taper is to allow your nervous system to accommodate to progressively less drug. If you insist on doing a faster taper, we may not be able to help you. You should know this in advance. Do not go faster than your nervous system is comfortable. We advocate a hyperbolic taper for good reasons.

[Nivsch]

On 7/23/2020 at 4:18 AM, Altostrata said:

 

If you felt the decrease, you're going too fast. Tolerance for decreases is individual. Your nervous system has the final decision. Your personal occupancy curve might have a slightly different shape than the average, which is what's in the journal articles.

 

I see you started out as a 10% skeptic. The reason we urge you to do a hyperbolic taper is to allow your nervous system to accommodate to progressively less drug. If you insist on doing a faster taper, we may not be able to help you. You should know this in advance. Do not go faster than your nervous system is comfortable. We advocate a hyperbolic taper for good reasons.

 

Yes I will listen to my body and take what you say into account. Before I started tapering I read carefully all the instructions about 10% method. I decided to do it in a form of 2.5% per week but very likely it is still too fast for me, so right now I do 1% per week, with an option to do twice 1% reductions per week only if I feel good enough, and keep listening to my body and fine tune the phase during the way slightly up alightly down along with my body messages.

[Altostrata]

That sounds like a very good idea. You can also take vacations from tapering if your nervous system signals it needs a rest.

[Nivsch]

3 hours ago, Altostrata said:

That sounds like a very good idea. You can also take vacations from tapering if your nervous system signals it needs a rest.

👍 I will consider it. and thank you again.

 

Just in brief more details about my decisions I hope it can be helpful to other people too:

 

I started to shrink my eating time to maximum of 8-10 hours (mostly 8 hours) and 16 hour fasting. I invested this issue and read it makes the body much more time to rest and repair and induce autophagy - recycling and repairing processes within the cells - much more efficiently! I also read that after 12 hours the body starts ketosis that also helps cell activities.

 

Until 2 months ago my eating times were realtively very bad. I ate heavy stuff right before sleeping and I sure it had part in my mental state. I think toxins in the brain is a problem of nearly all of us because in the western society we just dont let our body enough time to repair due to nearly 24/7 of digestion activity which make toxins to accumulate in our body during the years.

 

Also I moved this summer to 80%-90% of 801010 diet to support the healing process and from this week I started to eat only in sunlight hours.

 

In my opinion these issues are very important if not crucial things to the healing process. Of course one dont have to do necessarily 801010 and everyone can do his own unique way! But in the bottom line - less digestion time, more rest time to our body and cleaner food.

[Nivsch]

* In 'consider' I mean that I will do what you suggested to take a vacation if I feel that even the 1% per week will overwhelm

[Nivsch]

I have a question:

 

I think that the drug itself is part of my mental health difficulty, but I dont know for sure and I really want like a prove that will show me and it make me even more motivated to do the tapering (I will taper anyway because I feel its right for me).

 

I am asking because its not easy to know in my case. I also started just this summer totally new habits that are much more healthy like not eating at night, not eating all day long and soon also better sleep habits. Also nutrition itself and I see many people who improved mentally very much from this.

 

So there are two factors here - 1. Tapering 2. New habits. and both of them are long-term (months and more) built. and there is no way i will give up one of them and check only one at a time and wait for the full effect (one factor two+ years and then the other factor more two years...) because it will take me like five years in total and i really dont have patient for that and it seems to me unrational and not efficient.

 

So having said that, how can I get this kind of prove, that taking drugs for 10 years is actually interupting my mental health?

 

 

[Nivsch]

On 5/6/2011 at 10:26 PM, Altostrata said:

He said if the dosage of Cymbalta is "normal" -- 30mg-40mg -- he would switch to 10mg Prozac with a week of overlap. In other words, take both medications for a week and then drop the Cymbalta.
 

How can it be?

 

In the dose equivallency topic mentioned that 40 flouxetine/prozac = ~150 venlafaxine (= ~60 cymbalta/duloxetine(?) Is this also true?)

So if when I reach to 30 cymbalta I will want to switch to prozac it will has to be 20mg prozac and not 10. Or do i miss something?

 

I think about switching in the future because I get here the impression that tapering cymbalta is between so difficult to impossible 🤷‍♂️

 

[Altostrata]

That question is answered in tremendous detail here

 

[Nivsch]

41 minutes ago, Altostrata said:

That question is answered in tremendous detail here

 

 

I read it. I mean switching from 30 mg cymbalta to 10mg prozac and after the bridging - end up with 10mg prozac and stay with 10mg and then tapering from there.

But - i though that 30 cymbalta is equivalent to 20mg prozac and not to 10. Thats why i ask. I didnt find an answer for that in the discussion.

 

I based on the dosage equivalency topic in which you showed that flouxetine 40mg = 149 venlafaxine. Since my psychiatrist turned me from 150 venlafaxine to 60 duloxetine, I assume that 40 prozac = 60 cymbalta and therefore 20 prozac = 30 cymbalta.

 

Maybe I missed, and what the doctor you mentioned said is that cymbalta 30 is suitable to prozac 10 only during the bridging but after that you have to updose the prozac to 20.

 

Thats whats confuse me here.