Jonathan93: tapering Effexor XR, mirtazapine and sertraline

[Jonathan93]

Hello Community, 

 

so where do I begin? My name is Jonathan and I am from Germany. Im 27 years old .(Excuse me for my mistakes, I am not a native speaker)  

 

My mental health story began when I was 19 (2012) in September and I crashed big time and fell into a big depression mixed with anxiety. It actually did not come slowly like in some people, it was a matter of hours where I slipped into depression. I felt a big sense of meaningless, which was my main symptom. I cried in front of my parents and they took me to my GP. The GP sent me to a psychiatrist.

 

The psychiatrist told me to take Citalopram 20 mg 1-0-0 and Lorazepam 1-1-1 (lorazepam only for 3 weeks), since I felt really really bad I did not hesitate to take  the pills. Thinking back I am still not sure if it was the right decision, but it seemed the best thing to do.

 

I stabilised after a few weeks and the depression got less severe. I went to a psychotherapy while taking the pills and after 3-4 months after the crash I felt way more stable then before and Id say after 7 months I had my old life back. I actually got a girlfriend and life felt really good. I moved to another city after I finished School and since I felt really good, I thought it would be the best to quit the medication.

 

My psychiatrist told me to cut from 20 mg citalopram to 10 mg for a few weeks then go to 5 for a few weeks and then quit. This was in September 2013. I reduced from 20 mg to 10 and then after like 3 to 5 days I crashed and had huge waves of anxiety. I told my psychiatrist and he told me go up to the old dose. He told me that it seems like im not stable yet.

 

I took the 20 mg and my depression lasted a long time and was really severe. I actually had to move back to my parents house, since I did not feel that I can handle it alone. (its 2014 now ) In like march 2014 after a long episode of depression, I started to feel much better. After this I can not remember it that much. I started to become a nurse (3 years in Germany) and I remember trying to quit AD's for two times. Usually when I quit the AD'S completely I always started to crash after 1 to 2 months but after reinstating I got over it quicker then before.

 

So 2014 to 2017, I had some short episodes of depression, but I got over it quickly after taking citalopram again. Id consider 2014 to 2018 my most stable and best time. I never had the idea that it could be a crash of my body when I cut the AD's completely, but usually it would hit me after 1-2 months after quitting citalopram. In 2018 I feel into a big depression (trying to quit again)  and since that time I never really recovered even after taking my AD's again.

 

The psychiatrist told me to take 30 mg of citalopram and I felt really good for like a week, but then I had this phenomenal called Prozac-poop out and it did not work out.

 

We switched medications and he told me to take Effexor 75 mg and I had really high blood pressure in the beginning and felt kind of hypomanic for a few days. Then after like a week I experienced the poop out effect again and it did not work.

 

Then we upped the dosage to 150 mg Effexor and the same thing happened again. Felt good for a week and then it did not really worked anymore.

 

He told me that we should add Mirtazapine 15mg  for the night as an additional med. and I tried it since I was so desperate to feel better. It actually worked for like 2 weeks and I thought like "yeeeees im finally cured", but then again the poop out effect after a while.

 

We added Imipramine but I could not really tolerate the medication since I felt completely numb on it. I only took it for 4 weeks.

 

After that we added sertraline 75 mg and it worked again for like a week, but always the poop out effect, but my psychiatrist told me to stick on it, so I did and I trusted him.

 

On the 3 medications I had some good days but Id say about 70-80 % of time I feel  really depressed. I started to doubt that medication is the right way and for the first time I thought that the long exposure to AD's might have damaged me  and my mental health.

 

I got into anti AD's literature like Robert Whitman and other authors and for the first time I felt that the ADs might have been a terrible mistake in the long term.

 

My psychotherapist is also not a big fan of pills and with her support I managed to reduce from Sertraline 75 mg to 25 mg and Effoxor XR 150 mg to 62,5 mg. Mirtazapin 15 mg is the same dosage. it actually went pretty good, but the jump from 75 mg to 62,5 mg Effexor (4 weeks ago)  was really bad and still is. I struggle with really bad depression and anhedonia and in the beginning I had lots of anxiety and light sensivity cutting my dosage. I also suffer from DP and DR. 

 

So this is my story, I honestly feel really confused right now, but something in my body told me to get off all the medication. I honestly don't know if it is the right way, but something in me also has the need to find out what is behind the non medicated me. Im so confused, I really hope that no AD's is the right way but rn im really struggling with it. I read about the 10 % cut of ADS on here and the jump from 75 mg to 62,5 maybe was to rough, but honestly I don't wanna go up again. 

 

I really hope to find support on here and support other people.

 

Love from Germany 

 

Edited August 23, 2020 by ChessieCat
created paragraphs

[ChessieCat]

Hi Jonathan and welcome to SA,

 

To get you started we need you to create a drug signature please.  Please keep it simple so that we can see your history at a glance.  We do not need any explanation in the signature.  If we need more information we will ask you for it.

 

We need details for the last 2 years.  The best way to do this is to state the drug name and on the same line type the dates and the doses so we can see what changes you made.

 

For anything before 2 years ago, we only need a summary.  State the drug name, the year, the dose if you remember it and how long you were on it for.

 

Instructions:  Withdrawal History Signature

 

This link goes directly to where you can create your drug signature.  Remember to click Save.

Account Settings – Create or Edit a signature

 

 

Q:  What drugs are you currently taking and what doses?

 

Please put ALL drugs you are currently taking into the Drug.com Interactions Checker and copy and paste the results OR the link here in a post.

 

Once we have the above information we will be better able to assist you.

 

This is your own Introduction topic and is the place for you to ask questions about your own situation and journal your progress.

 

 

Edited August 23, 2020 by ChessieCat

[Jonathan93]

Hello Chessiecat, thank you for your fast and helpful reply. I edited my summary and it should be available now. 

 

Here are my drug interactions: 

 

https://www.drugs.com/drug-interactions/mirtazapine.html Mirtazapine seems to interact with Effexor (Effexor XR is not listed, does it still interact? I don't know...). Alcohol should be a no go. Mirtazapine can elevate cholesterols levels. 

 

https://www.drugs.com/drug-interactions/venlafaxine,effexor-xr.html Effexor XR interaction with alcohol, since I rarely drink, that's not tough for me 

 

https://www.drugs.com/search.php?searchterm=sertraline&a=1 Sertraline and Mirtazapin impact each other. Alcohol interaction. 

 

 

 

 

 

 

[ChessieCat]

Interactions between your drugs

Major

sertraline venlafaxine

Applies to: sertraline, Effexor (venlafaxine)

Using sertraline together with venlafaxine 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.

Drug and food interactions

Moderate

sertraline food

Applies to: sertraline

You should avoid or limit the use of alcohol while being treated with sertraline. Alcohol can increase the nervous system side effects of sertraline such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. Talk to your doctor or pharmacist if you have any questions or concerns.

 

Moderate

venlafaxine food

Applies to: Effexor (venlafaxine)

Alcohol can increase the nervous system side effects of venlafaxine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with venlafaxine. Do not use more than the recommended dose of venlafaxine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Antidepressants

Therapeutic duplication

The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'antidepressants' category:

• Effexor (venlafaxine)
• sertraline

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

[ChessieCat]

1 minute ago, ChessieCat said:

Major

sertraline venlafaxine

Applies to: sertraline, Effexor (venlafaxine)

Using sertraline together with venlafaxine 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.

 

Q:  Are you experiencing any of the above symptoms?

[Jonathan93]

Hello ! No , none of these symptoms! The only symptom I can think off is shivering, but this only happened when I tapered my Effexor XR so I do not think there is a connection. 

[ChessieCat]

Q:  Were you tapering both Effexor and sertraline at the same time?

 

SA recommends only tapering one drug at a time.

 

Q:  Which drug do you want to taper first?

 

Please provide the dates and doses for the following so that we can see what reductions you made and when:

 

2020 April + Sertraline 75 mg 

2020 April to now TAPER, Effexor XR 62,5 mg, Sertraline 25 mg,

 

Like this:

 

Sertraline:  date, dose; date, dose; date, dose

Effexor:  date, dose; date, dose; date, dose

[DataGuy]

Hi @Jonathan93

 

Glad you found the site, there is plenty of useful information here, most of it pinned in the topics sections. The non-pharmacological coping techniques can be especially useful.

 

If you are still experiencing DP/DR from your last cut, you may want to updose slightly (I know you said you didn't want to, but keeping your system stable is the safest and fastest way to get off these drugs). Information on updosing is available here.

 

Since you are going to be tapering multiple drugs, you may want to read this information on which drugs to taper first. I would recommend something like 1. Effexor  2. Sertraline  3. Mirtazapine. Getting rid of Effexor first is obvious, because it is generally more activating. Mirtazapine is very sedating (a "brake"), so we will save it for last. This assumes you are not having a major problem with any of the individual drugs. 

 

I think you may have read about why to taper by 10%, but just in case you haven't, I provided the link. It mentions that the taper can become more difficult near the end, so if you find you get an uptick of symptoms, it's ok to slow the taper down. This happens because the receptor occupancy of the drug decreases at a non-linear rate, so larger reductions in occupancy happen at lower doses, leading to bigger drops in the effect of the drug on your nervous system. The article mentions it is also best to be conservative, because once your nervous system gets destabilized, it can take awhile to recover. 

 

 

Here is an example of the receptor occupancy curve for Venlafaxine (Effexor) from this article. You can see that decreasing from over 100mg results in only minor changes in receptor occupancy, but once you get below 20mg the drop off in receptor occupancy is steep. This can result in stronger and more intolerable withdrawal symptoms. We solve this problem with hyperbolic, symptom-based tapering, reducing 10% of the previous dosage, and pausing or reducing more slowly if symptoms are unusually severe. 

 

I know we have given you quite a bit of information, so please take your time to read and understand. The best person to know all this is you, since you will be the one most intimately familiar with your symptom pattern and what your regular day-to-day "normal" is. This site has an abundance of information to help you understand tapering, withdrawal, psychotropic drugs and their benefits and risks. The best weapon you have to protect yourself from harm is knowledge, so we always encourage people to do their best to read and learn to the best of their ability so that they can direct their own taper with confidence. If you have any questions, @ChessieCat, I, or another moderator will be glad to help you. Sorry you've experienced so much suffering so far. Hopefully by removing these drugs slowly and safely, you can get to a better place : )

Edited August 23, 2020 by DataGuy

[ChessieCat]

@DataGuy

 

Jonathan has provided more information (dates and doses) in his drug signature.

[Jonathan93]

Thanks for the great support @ChessieCat @DataGuy

 

Yes Effexor , sertraline then Mirtazapin was my plan. If I would reinstate Effexor, like going back to 75 mg Effexor XR from 62,5. What is the best way reduce after the reinstatement. So 10 % would be like 7,5 mg of Effexor XR 75 mg but there are only 12 beads in my Effexor pill.

 

When I reduced, I reduced my dosage from 7 beads (75 mg) to 6 beads (62,5mg) which is like 16% to 17 % which is to much for tapering. Is it possible to liquify Effexor XR or are there pills with more beads so I can decrease by 10 %?

[DataGuy]

Hi @Jonathan93,

 

I just need to head out for a family get-together, but this article should provide some answers to your questions. I will be back later to check if another moderator does not step in to help : )

[ChessieCat]

Tips for tapering off venlafaxine (Effexor)

 

For later:

 

Tips for tapering off sertraline (Zoloft)

 

Tips for tapering off mirtazapine (Remeron)

[Jonathan93]

Thanks for the help .

Update of today, I really thought about reinstating to 75 mg Effexor but I struggle or hesitate to do it because all the suffering in the last 4 weeks would be for nothing, so Im still keeping up the dose and hope things get better soon. My main symptoms are anhedonia and depression. Sometimes I feel weird sensations in my feet, hands and face. I have to do some university work and hopefully I can get something done, its tough and I have to be really disciplined to get my work done.  Reading a book (for fun)(Henning Mankel) right now and it keeps me distracted for a bit. 

I also struggle with a lot of anger and frustration, Id consider myself pretty aggressive when I taper :/, The frustration and anger are caused by the anhedonia, because I barely feel anything positive. Hopefully it is a part of healing. 

[ChessieCat]

2020 April + Sertraline 75 mg 

2020 May, Cut from 75 mg Sertraline to 50 mg Sertraline

2020 June, Cut from 50 mg to 25 Sertraline 

2020 April Reduced from 150 mg 125 Effexor XR 

2020 May Reduced from 125 mg  to 100 mg  Effexor XR

2020 June: Reduced from 100 mg to 87,5 Effexor XR

2020 July: Reduced from 87,5 mg to 75 Effexor XR

2020 August: Reduced from 75 mg to 62,5 Effexor XR 

 

Please add the dates you made these reductions.

[ChessieCat]

30 minutes ago, Jonathan93 said:

really thought about reinstating to 75 mg Effexor but I struggle or hesitate to do it because all the suffering in the last 4 weeks would be for nothing, so Im still keeping up the dose and hope things get better soon. My main symptoms are anhedonia and depression. Sometimes I feel weird sensations in my feet, hands and face.

 

Q:  How many beads did you take out from 75mg to get 62.5mg?

 

Q:  Have you been on 62.5mg for 4 weeks?

[Jonathan93]

Hello chessiecat, 

in my Effexor are 12 beads (150 mg) so its 150/12= 12,5 mg per bead. 

 

I reduced from 7 to 6 beads, so from 75 mg to 62,5 mg. That was 26 days ago. I had some really rough 2 weeks after tapering, then 5 really good days and now I feel really bad again. 

[ChessieCat]

Thank you for the information.

 

I suggest that you try to get either some lowest dose regular Effexor tablets (immediate release) or Effexor liquid.  Tablets would be better to make your own liquid because I think the liquid is only viable for 1 month after opening.

 

That way you can "top up" you dose with a tiny bit more.

[Jonathan93]

Ok, that sounds like a good idea. I don't have Effexor immediate release on stock, but I will talk with my psychiatrist on the next appointment about it. That should not be a problem for my local pharmacy. 

 

 

[ChessieCat]

1 hour ago, Jonathan93 said:

I will talk with my psychiatrist on the next appointment about it.

 

A regular doctor can write a prescription.  You do not need to see a psychiatrist.

[Jonathan93]

Hello chessiecat, It is not that easy in Germany, as far as I know you have to be a psychiatrist to give the medicine out and since he's my practitioner who knows me, why should I not go to him?  If I demand the request to him he will make that subscription. If he does not cooperate I can go to a different doctor. There are plenty of them here, so it should not be a problem. 

[ChessieCat]

6 hours ago, Jonathan93 said:

If he does not cooperate I can go to a different doctor. There are plenty of them here, so it should not be a problem.

 

That's good.

 

I suggest to members that rehearse what they want to say to their doctor/psychiatrist before they speak to them.  You could write down a short note to remind yourself what you want to say.

 

how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect

 

 

[Jonathan93]

Thanks for the advice :). Ill use that. 

 

Im feeling a bit better since yesterday evening, hopefully it lasts a bit longer. Tomorrow would be 4 weeks and time to taper again, but since my body says no, im gonna hold it at 62,5  for like 2 weeks or longer if necessary. My next dosage will be Effexor 56,25 mg (10 %). 

[ChessieCat]

16 minutes ago, Jonathan93 said:

im gonna hold it at 62,5  for like 2 weeks or longer if necessary.

 

Yes, hold as long as you need to.

[DataGuy]

On 8/24/2020 at 5:28 AM, Jonathan93 said:

Thanks for the help .

Update of today, I really thought about reinstating to 75 mg Effexor but I struggle or hesitate to do it because all the suffering in the last 4 weeks would be for nothing, so Im still keeping up the dose and hope things get better soon. My main symptoms are anhedonia and depression. Sometimes I feel weird sensations in my feet, hands and face. I have to do some university work and hopefully I can get something done, its tough and I have to be really disciplined to get my work done.  Reading a book (for fun)(Henning Mankel) right now and it keeps me distracted for a bit. 

I also struggle with a lot of anger and frustration, Id consider myself pretty aggressive when I taper :/, The frustration and anger are caused by the anhedonia, because I barely feel anything positive. Hopefully it is a part of healing. 

 

 

@Jonathan93,

 

If your symptoms were severe enough that you thought about reinstating very recently, you should consider reinstating and avoid decreasing until you have been more stable for quite some time. This is going to be a very long process if you are going to do it safely, so it's best to pace yourself. I would not think of the suffering as "necessary" or as having been productive. The goal with tapering is to minimize suffering. If you read the Why Taper By 10% post, you'll remember that withdrawal symptoms represent neurological dysfunction and can result in some level of injury. These are things you want to keep to a minimum as much as possible, especially since you are just starting out. Some withdrawal symptoms may be unavoidable, but you want to avoid any impairment in function as much as it is within your power to do so. Hope you continue to feel better. 

 

@ChessieCat's suggestion to get the immediate release tablets is a good one. That way you can experiment with smaller reductions first and find out what is the optimal taper for you. 

[Jonathan93]

@DataGuy Hey thanks for the advice, It is doable right now, but from now on Im gonna be a lot more conciouss when tapering! I had some pretty good days (window), rn I think I might spiral into a depression again a bit, but it is managebale so far.

As I said the last few days have been good and there are little windows where I feel like my old personality is coming back since tapering. Gonna hold it on 62,5 for a while and see what will come. Exercise helps me for my depression. (I like to run and go the gym).

My family is pretty supportive for my mental health and they tell me that I can come all the time If I want. Since im 27 I do not want to depend to much on them, but it is really good to have this. Whats bothering me is that a lot of times I spent to much time gaming on my pc, which is annoying, but its also really addicting. When I am more depressed I play more on the pc because it distracts me, but honestly I think it makes me more depressed. Any advice for these little addictions like phones, pc e.g? I think long term wise it is a habit i really need to replace! 

 

 

[ChessieCat]

22 minutes ago, Jonathan93 said:

Whats bothering me is that a lot of times I spent to much time gaming on my pc, which is annoying, but its also really addicting. When I am more depressed I play more on the pc because it distracts me, but honestly I think it makes me more depressed. Any advice for these little addictions like phones, pc e.g? I think long term wise it is a habit i really need to replace! 

 

It's amazing how easy it is to get involved in what we are doing.  I have the same problem at times.

 

Suggestion.  Have another activity set up (eg jigsaw puzzle or whatever you might like to do, read/listen to a book and sit outside or somewhere different, even if it is watching a movie instead of gaming just so that it something different, or a project that you can do  in small chunks of time that you can leave set up somewhere or just a basic pack up so it is easy to return to doing), so that you don't have to make an effort when the time comes.  It's easy to get up and think ugh I can't be bothered and then sit back down and continue doing what you were doing (yes, been there and do that).  Having it ready helps to stop this.  Set a timer to go off throughout the day to remind you to stop gaming and switch activities.  Another thing  that you could try is not letting yourself play games until a certain time of the day and/or after you have done certain tasks.

 

It takes time to create new habits.  If you "fall off the wagon" try again the next day.

[Jonathan93]

Hey chessiecat, thanks for the advice! Ill do my best and Ill report how succesfull Ill be. Reading a book helps me a bit or working on something like university.

Last days were okay, the mornings are always tough for me. I think the anxiety since my last taper is gone, but the toughest thing for me is the anhedonic part. Id consider it the worst symptom of depression/withdrawal so far. Exercise and certain foods only help for a short period, but dont lift the anhedonic state longterm. I have some short windows like every 2-3 week where I feel like pretty good for 5-7 days and its always hard for me when I come to the realization that the good days are over again. My deepest wish for the future would a more longterm happiness and not this anhedonic state most of the time. (Bad days are also part of life but not like 80 % of my time) I guess I have to be patient, which is toooough, but I guess I dont have another choice. I will start to taper again at the end of september. I will go from 62,5 to 56,25 Effexor, now using "normal" release or not extended release Effexor.  

[ChessieCat]

  Another member recently posted this:

 

On 8/23/2020 at 3:00 AM, Brooke said:

 

I'd say it took about a year for me to feel "in control" of the waves. And by that I mean that they didn't scare me anymore, and my attitude was more of "put on your seatbelt, here we go again" rather than "oh no, what if this never ends and this is who I am forever?" Once I accepted them as part of the situation, they didn't have as much of a handle on me and I was able to work and live through them in a more productive and nurturing way. 

 

 

[Jonathan93]

Yeah, I get what you are saying. Easier said then done, acceptance is really hard for me, especially if you have once been full of life, desires and ambitions like a normal human beeing. But its true, acceptance is my only really choice.

 

Little story out of my life:

Yesterday I told a girl I liked since a few months, that I really like her. She said she liked me to, but more on a friendship level. It was tough for me, accepting this because I see her almost everyday. But I think it was the right thing, I'm not the person that likes the "what if", so now I have this out of my life and I can move on with my life.  Besides that I dont feel really good, I have the discipline  to do my everyday things but I continue to feel pretty anhedonic.

[Jonathan93]

I accidently forgot to take my beads out today. So i took a full dose of Effexor 150 mg   Any advice besides continuing the normal dose?

 

Edited September 8, 2020 by ChessieCat
Removed swearing spelled to get past the censure

[ChessieCat]

Please refrain from swearing.  You deliberately spelled the word so that it would get past the censoring.

 

Just take your regular dose at the same time from now on.  You might notice a difference in your symptoms for a while but things will hopefully settle back down soon.

 

At least you know about it, so you won't be wondering about what has caused any issues should they happen.

 

Try not to stress about it.  Added stress will only make things worse.

[Jonathan93]

1 hour ago, ChessieCat said:

Please refrain from swearing.  You deliberately spelled the word so that it would get past the censoring.

 

Im really sorry!  But I can assure you that I didnt write it different on purpose, just did not though about the rules! Thank you for the fast help, I dont feel different so far, maybe even more anhedonic but it could be just my mind.

[ChessieCat]

7 hours ago, Jonathan93 said:

Im really sorry!  But I can assure you that I didnt write it different on purpose, just did not though about the rules!

 

Thank you for apologising. 🙂  And I apologise to you for assuming that you have tried to bypass the censoring.

 

9 hours ago, Jonathan93 said:

i took a full dose of Effexor 150 mg

 

This is called a "dose change event".  It is best to hold on your regular current dose (62.5mg?) for longer.  The suggestion is to wait until you reach WDnormal and then at least another week after that before reducing again.

 

Edited September 8, 2020 by ChessieCat

[Jonathan93]

Hello, it has been a long time since my last post and I decided to write something again. I stayed on the dose of my effexor dose 62,5 mg for a pretty long time and I feel like my body needed this time time. I was on this dose for 10 week and I felt like I needed 6 to 7 weeks to feel alright again. The drop from 75 to 62,5 was to intense and I wont do such a drop in the future again. I reduced my dosage two days ago to 56,25 mg ( 10 %) and withdrawal symptoms are much better to handle then before so far. So far I only felt pretty anxious in the morning, but besides that I dont have any symptooms so far.

[ChessieCat]

I'm pleased to hear that holding for longer helped and that the latest 10% reduction hasn't caused too many withdrawal symptoms.  Remember that SA's recommendation is to hold for 4 weeks after a 10% reduction.

 

It takes about 4 days for a dose change to get to full level in the blood and a bit longer for it to register in the brain.

 

Something to be aware of for when you get to lower doses, possibly after 15mg or 10mg; there is no specific amount.  Many members find that as their dose gets lower they need to reduce less and/or hold for longer.  This topic helps to explain why this is probably the case:  Why taper paper: dose-occupancy curves

 

Also some members have found that there seems to be doses which they are more difficult getting past.  There is no "rule" as to what dose that is because it varies from drug to drug and person to person.  It's important to listen to your body/symptoms and hold when needed.

 

Another thing.  If rounding your dose for ease of measuring, always round up, not down, so that the reduction it less than 10%, not more.

 

Also be aware that it is better to try to get as low as possible/reasonable before jumping to 0.  I'm currently taking 0.56mg Pristiq (starting dose 100mg) and it seems really silly taking such a small dose.  However, from what I've seen here at SA from other members' experiences it is better to go slowly than to try and go too fast.  It's going to take me about another year to get to 0, but I've managed to get this far with minimal symptoms so I'd rather continue to go slowly and steadily for the rest of my taper.  When to end the taper and jump to zero?

 

Wishing you the best for the rest of your taper.

[ChessieCat]

I've just noticed that you are currently taking several drugs.  It is a good idea, once you get off a drug, to wait for about 2-3 months, or longer, before commencing the next drug taper.  Sometimes the brain can be making adjustments that we can't feel/notice and it's better to start from a nice, stable place than to taper too soon.  If you are concerned about whether you are ready to taper again you can always try a small dose test reduction to start with.