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BM1: What are the risks of going too fast?

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BM1

I have been trying to get off of effexor since February. I have been on some sort of AD since the late 90s. When one didn't work, I was prescribed another. I have been on and off of Paxil, Zoloft, Prozac, Celexa, Cymbalta, and others. I have stopped taking meds in the past for one reason or another with the typical effects. I have experienced a variety of physical and psychological side effects most of which have been mentioned somewhere or other in these forums. I always assumed it was a result of the depresssion not the medication withdrawal. This perspective eventually led me to return to a physician to get a new prescription as the illness and psychological affects were too debilitating. I have tried to wean myself off of Effexor this time and it has been difficult. I have dropped from the dose of 150 mg per day in increments of 37.5 mg or 18.75 mg as these were the only reasonable ways of splitting pills. I got down to the last quarter pill (18.75 mg) stayed there for a few weeks and then dropped that. I am experiencing sympmtons in my head (odd sensations when I move my eyes), fogginess, and a lack of good clarity. I am experiencing intestinal problems, tightness in my chest, and a lot of emotional instability. I cannot trust my emotions and reactions to things. I am functioning ok, considering but I think it is mostly because of the adaptive behavior I have developed over the years. I lay low, try not to overstress myself, and grind it out. I am so anxious to get off of this stuff and then take a fresh look at things to see what I need to do to live a more joyful and positive life. I have not completely ruled out any medication but after 13 years I need a fresh look at myself and my existence.

 

My basic question is: What is the risk of going to fast in the tapering? I have not doing the prescibed 10 percent per reduction per month which would take me nearly a year to get off this stuff or longer if you keep dropping by 10 percent of the current dose which would take forever. My feeling has been that I could gut it out and deal with the pain and symptoms and that my body needed to get used to being off this stuff to heal. The longer it is in me, the more hold it takes. I need to start the healing. Iknow there is no formula for this but do you think that rushing the process makes it harder for your body to acclimate to life without the drugs or do you believe that the body will do what it needs to do regardless. I am feeling pretty lousy now but resolved to hang in there if I know that life will improve. The problem is that lots of comments are made about it taking years to withdraw. Is this years to finally taper off, or years to feel good again? And I worry that I might be making my body adjust too quickly (although 5 months does not seem quick at all) and hampering the process. So, is the tapering process designed to be so slow to help me deal with the side effects better or is it to allow my body to readjust better because of it being so gradual. I keep feeling that each day will get better but not so far but I have only be off completely for a week. I want to give myself the best chance of kicking this stuff and righting the ship and don't know if I am. Thanks

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jr1985

From what I've read here and elsewhere, some people who taper too quickly end up suffering w/d symptoms for 2+ years. The alternative is that you take the same amount of time to taper slowly, only you won't be in hell while you do it. Why risk horrific protracted w/d, when you can do it nice and slowly, with minimal w/d symptoms?

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Altostrata

Welcome, BM1. I moved your topic here as your Intro topic so you won't have to explain your background again.

 

The danger in tapering too fast for your nervous system and experiencing withdrawal syndrome when you're off is that it may take a very long time for you to recover.

 

You may be determined to "gut it out," but there's no telling how long that will take.

 

If you haven't recovered within a few months before, you're not going to recover within a few months now. You may feel like you do now, or worse, for many months, even years.

 

There's just no way to predict how it will go for you. To avoid the worst possible scenario -- severe withdrawal syndrome for years -- we recommend taking the time for a gradual taper. It's a lot of work but it saves wear and tear on your nervous system.

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Karma

Hi BM1

 

I've been weaning off of Effexor since 2007 ... so 5 months is a fast taper. All the symptoms you are describing are withdrawal symptoms. I get that you want off of the drugs, but the reason one does this slowly over time is to allow the brain and nervous system time to adapt to being without the drug.

 

I'm down to 38 mg of Effexor (had been down to 18.75 mg before I got terrible dread, anxiety and irrational fears). I am currently getting compounded liquid Effexor. I am tapering at about 2 mg every 3 to 4 weeks - so I've actually reduced to only 5% decrement at a time. Yes, it will take me possibly another year and a half to come off, but I do not intend to suffer through this taper.

 

If these withdrawal symptoms continue, based on my experience I would recommend re-instating your dose of 18.75 mg. Are you taking extended release or regular? If regular you can get 25 mg tablets and cut them up using a jewelers scale to manage reductions. Regular effexor can also be compounded into a liquid suspension so that you can reduce by smaller increments.

 

Hope something here is helpful ... I just have to be very honest about my journey - your experience may be different.

 

Love and light,

Karma

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BM1

Thanks for the feedback. I guess the difficult thing for me is knowing what is acceptable and determining what is too fast or too slow. I have had symptoms all the way even when I felt like I was going slow. I have my days even when I am on the medication. I am very susceptible to stress and have a stressful job so feeling a bit off is a way of life for me. I tend to separate the physical from the psychological/emotional symptoms. If I feel the brain zaps or headaches that is a very uncomfortable thing that I want to stop. If I feel a bit edgy or stressed that is something that is not so uncommon so I tend to put up with it. I guess my question now is what do I do to retrace my steps. I had gotten down to 18.75 mg before stopping and could go back to that but I am not sure I was even very comfortable there. I do not want to go back all the way and start over. I took a 1/8 pill (9 mg plus or minus) last night, to try to stop the physical symptoms and try a slower taper to zero. Despite all the buzz about things taking time, I tend to experience things very quickly. I feel a little less impacted this morning. I am confused whether I should go back to an earlier dose and continue at a much slower taper or do I pick up where I am at and continue from here. It is all such a crap shoot. I went through this with the Dr when he was trying a different pill every week to see what worked. It is kind of a catch 22, and flying in the dark. I could go back to 19 or 37 or even 75 mg and not really know whether it is the right place to start. I just do not want to retrace steps but I appreciate that the body needs to adjust. I just always felt that the body is more resilient and could make the changes as changes was needed. I think the body can accept some stress in recovering, the question is how much. Do people really feel no symptoms when they taper slowly or is it just easier to accept? If it is the later, then I am back to my original question, how much pain, discomfort, is acceptable and what symptoms are acceptable? When you are used to feeling off it is difficult to determine how much off is ok?

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Nikki

Hi...I wasn't going fast and I was making small cuts and then I got brave and impatient and dropped another 1/5 mL last night - and - I am paying for it now.

 

I have wd symptoms which I was to mostly avoid before this drop.

 

I am what you would call Hard Headed :(

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BM1

So with the slow taper, there are virtually no symptoms or is it a matter of degrees. I just have a hard time recognizing what is an acceptable level of withdrawal symptoms and what is too much stress for the brain handle. I am really not trying to push the limit but want to make progress and optimize the process. I can tolerate some discomfort personally but I do not know whether the brain pays for my efforts to ensure some discomfort. Obviously if there is no rule book or recipe for this but I think there is always some measure of withdrawal that one will experience so in some sense you have to be able to endure some discomfort. I just do not want to overstress my system. I am not convinced that there is a definate correlation between what a person feels in terms of syptoms and a ability of the brain to repair or correct what needs to be corrected. Sometimes pain is a warning to stop something, and sometimes it is an indicator of something that is being stressed but not to a critical level. The body has amazing recuperative ability. I believe that sometimes we have to push ourselves to get better.

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Nikki

I believe that sometimes we have to push ourselves to get better

 

I have done several tapers and crossovers. I am a real fighter/survivor and I do what I have basically done when not withdrawing. I get 'crazy' sitting around.

 

There were many times that I had to lay down and rest. Didn't like it, but I had to do it. The physical ailments don't really bug me.

 

It's the mental/emotional consequences from a taper which is fast, and large cuts in dose that absolutley level me.

 

I get anxious/depressed/confused/forgetful. As my self-esteem takes a nose dive, my self-doubt escalates. A fear/desperation sets in and this scares the daylights outof me. What can really complicate this is insomnia. The physical symptom that most disturbes me is when I awake after a drop, my brain feels like jello. It feels like it is not attached to my skull. Strange feeling.

 

My concern for myself is that I don't want to end up with Protracted Withdrawal. These meds have already robbed me of a number of years out of my life. It was my choice to take them.

 

I say push yourself to get outdoors....it can do wonders, but for some this is almost impossible because they are suffering so much from being polydrugged.

 

Okay I am finished with my Soap Box...

 

Hugs

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Altostrata

BM1, you only have one nervous system. Don't be heroic. Zaps and so forth are signs your nervous system is in distress.

 

Don't push it to unbearable suffering -- those symptoms can get much, much worse -- before you take care of it.

 

Tapering slowly and carefully is much better for you in the long run.

 

That you updosed slightly (1/8 pill) and felt better demonstrates you're going too fast for your nervous system. You want to go as slowly as it needs to adapt fairly easily to changed.

 

You're taking regular Effexor? You may wish to get a digital scale to measure your doses.

 

The indications are your nervous system is sensitive to small changes and you want to be able to control your dosage. See Tips for tapering off Effexor and Effexor XR (venlafaxine)

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BM1

Believe me, I am not trying to be heroic. It is not a question of what is bareable but what is acceptable and "normal" I do draw the line at brain zaps but if they are unavoidable and will a short event, then I can suck it up and deal with it. I am trying to understand whether all of this is avoidable if slow taper is the process or whether some sort of discomfort is unavoidable. I am on basic venlafaxine. I tried the ER and it did not like it. I got a presciption today for 25mg tablet so they will give me some flexability in reducing the dose. I will consider a scale but that seems like a bit of work and I do not really want to become a chemist or pharmacist in the process. I will try to figure it out as I go. I am back on 1/8 tablet and seem to be stabilizing. If that works I will drop slowly from there after a 3-4 week acclimation period. If I do not stabilize I will go back to 18.75mg until I stabilize. As I said the emotional rollercoaster is often a function of my daily stress etc and not easily directly relatable to meds. But the physical symptoms are a different matter. Thanks for the suggestions.

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Rhiannon

Well, if you've read any of my other posts elsewhere, you know what I think about going fast.

 

I just want to add that I've seen this before, where people take it as a personal challenge to "suck it up" and just push past symptoms, as if that were going to help. Unfortunately pretty much all the time that just leads to a crash. What needs to happen is healing. That involves complicated cellular and chemical and gene changes that can't be rushed no matter how strong or tough you are.

 

It's not a contest of "me versus the drug" here. Willpower doesn't help. Being tough is irrelevant.

 

Personally I suspect that the risk of going too fast is that you go faster than the healing/rebalancing processes can keep up with, create a level of biochemical chaos that actually prevents further healing and rebalancing, and the CNS just does whatever it can to keep the organism alive. What it has to do just to maintain life may not be what's best for actual healing and wellbeing. And you can end up tangled and mangled and it can take a really long time to recover. Personally I suspect this is at least part of how people end up in protracted withdrawal for years.

 

Keep in mind that our CNS doesn't really know how to heal from these injuries. It's not like a cut or broken bone or a sprain. It's stupid to "suck it up" and push past those kinds of injuries too IMO, but if you do you might be okay because your body knows how to heal those things, so it can heal them in spite of further stress. But your CNS doesn't really know how to heal from what these drugs to do it, because nothing like these drugs has ever been encountered before during evolution, so we haven't evolved ways to fix what they do.

 

So, that's why I use the word "mangle"--I really think we can end up pretty screwed up if we try to force our bodies to fix this stuff too fast. They're going to consider it a threat to survival and just do whatever they have to do to keep us alive, even if that means connections and cells and epigenetic changes that are not optimal or maybe even pretty bad. And probably not quickly reversible. To the organism, if it's a question of death, pain and dysfunction are acceptable.

 

Especially an organism that's just flailing around in the dark. (Which is how our CNS reacts to these chemical changes caused by the putting in and taking out of psych drugs.)

 

Why do that if you don't have to?

 

That's my opinion. Basically, IMO, the risks of going too fast are way, way greater than the inconvenience of going slow.

 

And probably except in extreme cases (or very short term use) also greater than the risks of staying on the drug longer while you take it slow. Although that's an algebra that has to be calculated by each individual based on circumstances.

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Altostrata
Brain zaps are not normal under any conditions!

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BM1

Thank you everyone for the feedback. Trust me, I am not trying to tough it out or push the envelope or break any speed records. I am just trying to figure this out. I have not gotten a clear answer of what to expect even when you are going as slow as needed. I expect some symptoms even when I am doing everything right. Is that correct or is the tapering supposed to be symptom free? I would start to feel withdrawal in the morning when I was at my normal dose a couple of hours before getting up because my body wanted/needed more. I would get weird dreams and physical symptoms before taking my pill each day, so it seems that any reduction with my sensitivity will result in some discomfort and withdrawal experiences from my body. That being a given, I am trying to figure out what to expect and be able to identify when I am going to fast. I do not think it is a good thing to lower a dose, even by 10 percent, and then raise it again if I get symptoms, and I expect to get some symptoms regardless. I am just trying to understood what I should expect and what is a reasonable and expected level of discomfort and range of symptoms. I get it, I need to do this slow as possible to let myself heal. I am on board with that and I very much appreciate the input. My brain is not zapping right now, which is a good thing and progress I think, but I am still pretty easily agitated and body is sending me some other strange messages. But I may be cranky and out of whack by nature, especially at my age.

 

You folks are great and generous with your time to try to help me steer through this. It is all uncharted waters for me so the subtleties of the landscape elude me. Thank you.

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Altostrata

According to Joseph Glenmullen, the rate of taper should be adjusted so that withdrawal symptoms are all but absent.

 

If you have withdrawal symptoms that last for more than a few days and don't lessen in intensity over that time, you're going too fast.

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BM1

Thank you. That is what I was looking for clarification on.

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Karma

Hey BM1,

 

A slow taper should result in virtually no symptoms. An acceptable withdrawal from Effexor would mean that you might feel a night of night sweats a day or two after a decrement, you might feel irritable or slightly blue a day or so after a decrement, but you should be able to stabilize to a point where you feel "normal." You might have a night or two of disrupted sleep. In general if you have some mild symptoms one to three days after a decrement and then it improves, you are probably about right.

 

Irrational fears would be a symptom of withdrawal. GI symptoms would be a symptom of withdrawal. Excessive anxiety would be a symptom of withdrawal. Brain zaps are a definite sign you've gone too far. Shakes or a sense of dread are indications you've gone too far. When you've gone too far you need to up-dose or hold until you feel normal for a number of weeks.

 

Hope that helps.

 

Karma

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Nikki

According to Joseph Glenmullen, the rate of taper should be adjusted so that withdrawal symptoms are all but absent.

 

If you have withdrawal symptoms that last for more than a few days and don't lessen in intensity over that time, you're going too fast.

 

Thanks Alto.....that's the answer on how to taper which is what Rhi has been saying.

Sadly for most of us it does take a long time. I have a problem with the time issue.

 

Rhi...yes, I thought I should learn how to "tough it out". It sure doesn't work like that after a drop when the symptoms come on like bear.

 

We (or should I say I) have these moments of insanity, when I am feeling well and I think "oh I can do this".

It turns out to be sheer misery.

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BM1

Thanks for the feedback. I took a look at my withdrawal from effexor and I certainly took a much quicker approach than this site prescribes. I did not know of the 10 percent principal at the time. Here is my chronology:

Started at two pills per day (150 mg)

lower by half pill to 1 1/2 pills on Feb 24 (25% reduction)

11 days later, lowered by a quarter pill to 1 1/4 on March 6 (17% reduction)

7 days later reduced by a quarter to on pill a day on March 15 (20%)

17 days down to 3/4 of a tablet on April 1st (25%)

12 days later down to one half pill on April 13 (33%)

18 days later reduced to zero on May 1st.

Couldn't handle it and went back on. I have been struggling since at 1/4 pill and just went back to 1/2.

 

My question at this point is what is the best way to retrace my steps. I am hoping that I can stabilize at 1/2 pill (37 1/2 mg) and then reduce from there but if not do I keep going back up and by how much.

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Altostrata

Often you can stabilize at a lower dose. 37.5mg may be enough, give it some time. (These medications are much stronger than they need to be.)

 

If it isn't, you can gradually titrate up. You still may not have to retrace all the way.

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BM1

I have been taken 37.5 mg the last few days. I have been wound tight as a drum. I have experienced a lot of stress at work but even when I get off, I have a hard time relaxing. I am really very tight. Is this just an adjustment since I went back to a higher dose or is it an indication that I need to take more. This is the part of the trip that is difficult for me. I need to find a stable dose but what is stable is the real question. I can sympathize with Tom from the other forum. We are between a rock and a hard place. Deciding what is normal is so hard to do.

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Nikki

BM1

 

Finding the right dose is really up to how you feel. If you can't go on - up it again until you find relief. You have to do something and this is the best solution for now.

 

The right dose is when you feel relieved and think to yourself you can go on, or Thank God I am starting to feel better than I did yesterday.

 

That's how I did it.

 

Hope you get relief soon:)

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BM1

Thanks for the input. The problem that I have is knowing when something isn't working or adjustments need to be made. I seem to be pretty sensitive to medications but the literature and many people's experiences show dramatically different timing on how and when things affect you. Some say you will experience results in a few days, some say two weeks. Some people seem to get impacts much later. When trying to make decisions on whether to go up or down in dosage, I want to make sure I have given my body time to acclimate to the medication or the changes and give the medication time to do its thing. Do I wait a week, a few days, two weeks? If I feel lousy, I do not want to pull the plug on the current plan or dosage until I know I have given it enough time to take effect. There is a delay in the drug getting into the system and I presume a delay in your body acclimating. If everything were instanteous, it would be much easier to react.

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Altostrata

It takes about 4 doses for the blood level of the drug to reach steady state.

 

Have your symptoms changed at all since you started taking 37.5mg?

 

Yes, it is hard to make these decisions. It's a failing of medicine that we can't find doctors to guide us in these situations.

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BM1

Do you mean 4 days? I take a quarter pill twice day. It has been 4 days today. I have been feeling very wired and stressed but it has been a stressful week. But given a stressful situation, my stress level just elevates dramatically. Today has been easier so I have not been stressed. I feel ok otherwise. I have felt a few other odd physcial symptoms which i can never pinpoint where they are coming from. I have had dreams, cold sweats one night early in the week, and cold symptoms in the morning for two days but they have not persisted. I do not have a great appetite but am eating. Other than that, top of the world. A lot really depends on the demands placed on me. Yes, I wish the medical profession had a better handle but they seem to take the lead from the drug companies. When I renewed my dose the other day to get 25 mg pills to provide me more options for splitting, I asked the pharmacist what doses they come in. He told me there is no liquid and 25 is the smallest. I told him I was trying to wean off the drug. He told me to just reduce by a half pill at a time over a few days. I disregarded his advice.

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BM1

Thanks. If it doesn't settle down I guess then I need to go back up by a quarter tablet or so.

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Altostrata

I don't know. If you get more nervous or you can't sleep, it may mean you're taking too much.

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BM1

Good point. I'll take it a day at a time and see how I feel. My nervous system is obviuosly very jumpy right now. A little R&R may help it settle down. Thanks for your thoughts.

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Altostrata

BM1, how are you doing with withdrawal now?

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BM1

Thanks for asking. I put another post out yesterday under the topic How do you know when you need an antidepressant. I am holding somewhat steady at 25 mg. I do not experience many noticeable physical symptoms but I have a general lethargy and low BS tolerance. I am just not very happy or enthusiastic about anything. I am committed to dropping slowly from here but I am now questioning whether I ever going to feel at peace and happy with my life. I am trying to stay positive but it is a long haul and I would really like to feel more joy in my life and feel better about myself.

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Altostrata

I am now questioning whether I ever going to feel at peace and happy with my life. I am trying to stay positive but it is a long haul and I would really like to feel more joy in my life and feel better about myself.

BM, please consider whether accepting who you are and making changes in your life to bring more pleasure into it might not be a better route to your goals than medication.

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BM1

I have been tapering off of effexor since February. I started faster than I should have and endedup going back up to what I considered a save level before subscribing to the 10 percent ever 4 week approach. I have dropped from 150 mg to about 16 mg taken as 8 mg twice a day. I don't feel great but have no idea whether what I am feeling is withdrawal, depression, or some other symptom of getting older. I do not have dramatic sypmtoms like I experienced when I first started tapering but have some symptoms every day. I have had headaches for several weeks now. I have digestive issues, achiness etc. Emotionally I am not very strong. Lots of self doubt, little motivation to socialize, and general lethargy and lack of optimism of any sort. One of the problems is that I am under a lot of stress at work. Stress is very hard on me. I suspect that is a large part of the issue. But how do I know? I am seeing a counselor weekly. I do not have a very fulfilling life outside of work right now but have little motivation and few options to change that without a lot of effort which I do not have motivation or energy for. So the reoccuring question for me, is do I stay the course and continue to drop my dose by ten percent every month which will take 8 to 10 months to get free of this stuff or do I alter the approach in any way. I feel like I am in limbo and need to find some relief. I need to change this day to day drudgery of feeling lousy and cannot even fathom feeling like this for another 8 months. My family is questioning whether I should get back on this or some other medication. I know that I have to change something to improve my situation but the question is what. I am very tired of feeling lousy. Any input, thoughts or encouragement would be appreciated.

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Altostrata

BM1, I moved your post here, to your topic.

 

Congratulations on managing your taper to this point. To differentiate withdrawal symptoms from other types of symptoms, I suggest you hold at this dosage. Stop tapering and let your nervous system catch up.

 

Yes, this may delay your going off the medications completely, but your quality of life might improve, and that's the point, isn't it?

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BM1

I will try to hold, as I intended to do for a few more weeks until the month was up. But, how long after that? If I feel this way for a second month, then what? wait another month? I cannot continue to head into the winter feeling this poorly.

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Altostrata

Hopefully, you will feel better as your nervous system adapts. You might have been going too fast before.

 

Hold for more than a month. Don't make another reduction until you feel better.

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BM1

But I have been following the prescribed 10 percent drops every 4 weeks. I have not felt good in months.

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