Carolina: How to calculate dosages for taper

[Carolina]

Hi SA community,

 

I am planning on tapering in about three months time. I crashed after a too fast taper and had to reinstate my original dose. I ended up hospitalized. Was a truly frightening experience. I tried to argue that the symptoms- insomnia, panic attacks, and suicidal thoughts-  were due to withdrawal and not ‘ a return of my disease’ ( I never had anything except social anxiety prior to starting these drugs) and was told I was delusional. They tried to place me on an antipsychotic which I refused. 
 

in any case, I have used the brass monkey calculator for my planned taper ( 2.5 % and 8 week hold). I plan to go as slow as possible to minimize effects and allow my body to heal.  However, how do you calculate the dosages using pills? For example, my first tapering dose would be 19.49.... how do you suggest calculating the .49 dosage? 
 

Thank you for your support and help. 
I hope everyone is healing as best as possible. 
 

 

Edited January 1, 2021 by manymoretodays
name to title

[Carolina]

This whole experience has, is and I am sure will continue to be a nightmare. Wish I had never touched these poisonous drugs. I am 31 years old and was trying to get off of ADs to become pregnant. I absolutely refuse to have a child on medication ( don’t know the effects these drugs will have on a fetus). How many lives has big pharma ruined? How do you mourn a life that you thought you would have and may no longer experience? 

[Shep]

Hi, Carolina.

 

Here is some information on withdrawal to get you started: 

 

How psychiatric drugs remodel your brain

 

Healing from antidepressants. Patterns of recovery video (4 minutes)

 

The Windows and Waves Pattern of Stabilization

 

Before we get into tapering specifics, please tell us more about the drug you are currently taking and any psychiatric drugs you've taken in the past. 

 

 

Please add a signature.  Include drugs, doses, dates, and discontinuations & reinstatements in the last 12-24 months. Also include supplements. This will help us give you the most accurate advice we can. 

• Any drugs and supplements prior to 24 months ago can just be listed with start and stop years. 
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago) 
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016. 
• Please leave out symptoms and diagnoses. 
• A list is easier to understand than one or multiple paragraphs. 
• This is a direct link to your signature:  Account Settings – Create or Edit a signature.

As you provide more information, we can better guide you in setting up a taper. 

[Rosetta]

Carolina,
 

You asked in my thread if it was worth it to get off ADs.  Yes, but if you taper, you shouldn’t struggle the way I have.
 

In fact, it is very important that people seriously consider tapering off.  Very.  What I would not recommend is staying on ADs because you will need a higher and higher dose, and someday you will reach tachyphylaxis.  That is unplanned, uncontrollable WD despite taking your dose.  These drugs are addictive!  The fact that there are no cravings means nothing!  The body adjusts to the substance and needs more.  It reacts to the lack of the substance, sometimes quite violently.  That is addiction.
 

The idea of a taper is to keep the discomfort at a minimum and slow the taper if it gets to be too miserable.  
 

As far as having a baby on ADs, of course it’s not ideal, but many people have perfectly healthy babies while on ADs.  Some don’t.  I suppose I’m glad I didn’t know of the risk because I can’t imagine how empty my life would be without my daughter.  I was on Celexa at the time, and I think it was probably 40 mg.   I don’t remember.  The baby did go through withdrawal, and it was horrible.  I thought it was colic, but I now know it was WD.  So, I’m not suggesting someone go on ADs (well, ever for any reason), when she is wanting to get pregnant.  However, if you are on Lexapro, and you are 31, you know you may need to start trying soon.  It’s not an easy decision.

 

How many mg are you taking?  I’m so sorry to hear of your experience with the doctors.  It makes me angry.  You will stabilize or maybe you have all ready?  I don’t want you to think that tapering and CT are the same degree of discomfort.  They are not supposed to be.  You can make the amount of the reduction smaller or you can wait longer periods between reductions.  You are in control to a large degree.  There may be hiccups, but what happened to you before would not be expected.

 

Probably the most important thing is to never miss a dose and to take it at the same time every day.  Never accidentally take a second dose either.  Always use a pill caddy.  Of course, this is true for people who are not tapering as well.  Our bodies are very sensitive to these drugs, and the timing is important.  Some people don’t feel the effects like others, but it seems that once a person has been in WD, her system is more sensitive to timing and missed doses at least for a few weeks or months.

 

Oh, and never take benzos.  Never try to cover the anxiety caused by ADs with benzos or alcohol.  Just don’t.

 

Good luck @Carolina

 

Yours, Rosetta

 

[Carolina]

Asking for advice. 
 

Around October 2020, I unknowingly CTd Lexapro ( 20 mg) after taking it for 8 years. I reinstated my original dose in December and have been ok since. I have ruminating, intrusive ocd thoughts as well as SI. Other than that, I am functional.

 

How long would you suggest I wait until I start a slow taper?
 

Is there anything I can do prior to tapering to increase my chances of success?

 

Are WD symptoms manageable at slow taper rates ( meaning will I be able to function during the day? 

 

Thank you!

[Shep]

Here are some links that may be helpful:

 

Withdrawal Normal

 

Before you begin tapering - what you need to know

 

Tips from members: Preparing to taper

 

 

[Carolina]

Thank you for the information @Shep

 

 

@Altostrata

I have a question about 'life on the other side',  meaning once one has successfully gotten off of ADs. 

 

Do you feel less 'numb' to the positive neuro-emotions as well ( meaning can you more fully feel joy, love, etc?) or are those emotions still numbed in PAW ( like they are on ADs)? Does life, then, become a combination of WD normal and abating waves with learned coping skills?

 

Just looking for motivation to get through this very long and arduous battle 

 

Thank you

 

 

 

[Altostrata]

Please read these and other topics in the Symptoms and Self-Care forum:

 

The Windows and Waves Pattern of Stabilization

 

Are We There Yet? How Long is Withdrawal Going to Take?

 

"Is it always going to be like this?"

 

The importance of recognizing you're feeling good

 

Creating a new self after withdrawal

 

Protracted Withdrawal or PAWS (post-acute withdrawal syndrome)

 

Progress! What withdrawal symptoms have gone away for you?

 

Withdrawal dialogues & encouragement

[Shep]

17 hours ago, Carolina said:

I have a question about 'life on the other side',  meaning once one has successfully gotten off of ADs. 

 

In addition to the great links Alto posted, please also see:

 

Success stories: Recovery from withdrawal

[Carolina]

Thank you for the information. Just wondering if the good emotions are numbed completely during PAWS or do you gain all your emotions back at one point?

[Shep]

Your emotions do come back, but it's slow. And that's a good thing. It gives you time to practice your non-drug coping skills during waves so that when your emotions do come back, you're not overwhelmed by them. Being emotionally numbed down by drugs for years and then being numbed down by withdrawal for months or years can leave you vulnerable to overwhelming thoughts and feelings. Even good emotions can be overwhelming. Trust that your mind/body knows what is best for you and let them guide and teach you what you need to do to prepare for living drug free. 

 

Mindfulness and breathing exercises can be great for preparing for when your emotions do return. You can find some information on that here, along with many more ways of coping: 

 

Non-drug techniques to cope with emotional symptoms

[JesusSavemefromWD]

On 1/1/2021 at 10:56 AM, Carolina said:

Hi SA community,

 

I am planning on tapering in about three months time. I crashed after a too fast taper and had to reinstate my original dose. I ended up hospitalized. Was a truly frightening experience. I tried to argue that the symptoms- insomnia, panic attacks, and suicidal thoughts-  were due to withdrawal and not ‘ a return of my disease’ ( I never had anything except social anxiety prior to starting these drugs) and was told I was delusional. They tried to place me on an antipsychotic which I refused. 
 

in any case, I have used the brass monkey calculator for my planned taper ( 2.5 % and 8 week hold). I plan to go as slow as possible to minimize effects and allow my body to heal.  However, how do you calculate the dosages using pills? For example, my first tapering dose would be 19.49.... how do you suggest calculating the .49 dosage? 
 

Thank you for your support and help. 
I hope everyone is healing as best as possible. 
 

 

Hi Caroline , 

I am so upset every time I hear doctors who Do NOT recognize WD and want to put a patient in antipsychotics to make things worst (and most of times don’t even inform that it is an antipsychotic). They tried to do this with me as well... after being on a low dose of Zoloft for just a few weeks I started having out of my body experiences, panic attacks, intrusive thoughts, depersonalization, depression, tinnitus and paranoia (never had any of these before Zoloft, I started Zoloft due to work related anxiety triggering intense chest tightness). Instead of the reasonable explanation that these were Zoloft side effects, I was told that I was probably developing a serious mental illness and I ll need to start an antipsychotic and stay in an AD for lifetime. I am so greatfull to God that u and I both refused the antipsychotic!!! I am now 3 months OFF Zoloft and most of these feelings have disappeared (except depersonalization but has been reduced a lot).

I agree with u trying to get off ADs before u start your efforts of having a baby, because the truth of a matter is that u really don’t know if the fetus will be affected or not, and better not to take the risk. 
I also want to tell you to not a prior think u will have hard time tapering... there are a lot of people who rapper very slowly and have manageable symptoms. Be prepared but don’t assume the worst will happen for you. The trick is to start tapering at 5 to 10% reduction  staying a few weeks on each reduced dose, but also listen to your body while ur doing this and adjust tapering plan accordingly. You are still young and u have time to have beautiful and healthy babies.

Take care

[Neon]

hey @Carolina,

just wanted to say hi and I hope you are doing reasonably well.

I see you got a lot of great advice already. 

I can tell from my personal experience that meditation and mindfulness has helped me A LOT to deal with the difficulties of withdrawal. A lot of people do well with yoga, so maybe if that is something you are interested in, you can try. I think it is good to learn techniques before withdrawing or early on, so you have them at hand when some difficulties arise.

 

Also I wanted to let you know that I know of three mothers who have had happy, healthy babies while they were on ADs (two of them are 18 and 16 by now and doing really well, the others to be faire are still babies but they are very cute and healthy). I do not want to advocate for pregnancy while on ADs and I would definitely prefer to have children while not on it. You never know of the risks. But I just wanted to mention it in case you are in a now-or-never situation type of thing.

 

I wish you all the best and lots of support!!

[Carolina]

Thank you for the support guys!

 

I am trying to make a list of my main motivations to get off ADs to go back too when in waves and one of them is to feel again. Even in beauty there is darkness. I wish someone had told me that when I was younger. I hope to feel the good as well as the bad again. So I am glad to hear that ALL emotions do come back @Shep, albeit when given time. I hope that is my case. 

[Carolina]

@Altostrata @Shep Based on your experience when is a person ready to commence  a taper, with a greater likelihood of success, post  a too fast taper that destabilized the CNS? 
 

I would appreciate your advice as I know this is one of the riskiest ways to begin a taper. Are there certain markers of stability that I should wait for? I was planing to wait six months. Should I wait longer? 
 

Thank you. 

[Altostrata]

Carolina, do you still have withdrawal symptoms? How are you feeling now?

[Carolina]

Thank you for your quick response @Altostrata

 

I still have 24/7 ruminating thoughts ( about medication, WD, and how unscrupulous and uninformed/delusional the psychiatric community is), intense SI in the mornings and evenings, and insomnia. Not ideal to start a taper.  It has only been two months since my crash. I understand that the trickiest way to start a taper is post CNS crash. 

 

Overall, these symptoms are ‘stable’ in the sense that they are pretty consistent each day. No waves or windows, just a pretty consistent pattern of symptomatology. 

 

I was thinking of waiting six to eight months. However, do you suggest waiting until most of the withdrawal symptoms have dissipated or abated? I am truly impressed by @bubblesand @ChessieCat tapers and hope/plan to follow their approaches. It will be a long taper so I don’t have too much of a rush to start tapering apart from the intense urge to have these medications out of my body ( now that I truly comprehend how dangerous they are).

[Yesyes123]

@Carolina, hello!

 

I am in pretty much the exact same situation. I have been on Lexapro for 6 years (since I was 15) and tried to come off of it last year, not having any idea of the terror I was getting myself into.

 

It's been nearly 4 months since I reinstated (unfortunately, at a higher dosage - 15mg - I always took 10mg. This was another mistake from my psychiatrist.)

 

What is your current dosage? Please wait at least 3 months before starting your taper. Peace and healing

[Altostrata]

Please describe what your crash was like when you went off Lexapro.

 

You're taking 20mg Lexapro? Are you still taking Remeron? At what times of day do you take your drugs?

[Carolina]

Thank you @Altostrata

 

1) Description of crash: became a complete insomniac, had suicidal thoughts, experienced ruminating obsessive thoughts 24/7, inability to eat, brain zaps, and ended up in a psychiatric hospital.

 

2) I am taking 20 mg Lexapro at 9 am

 

3) I am taking 15 mg Remeron around 9 pm 

 

My plan was to begin slowly tapering in June. 
 

1) should I start tapering the Lexapro or Remeron? 
 

2) should I wait longer?

 

3) any advice is welcome 

 

 

[Yesyes123]

@Carolina,

 

Are you stable now? Do you still have any symptoms?

 

I had a huge crash from coming off Lexapro October last year and I am just now getting stable. I plan to wait at least a few months before touching my dosage.

 

Maybe June is a good target to start. I already ordered a Gemini 20 scale for weighing my crushed pills.

[Rosetta]

Dear Carolina,

 

You left a message on my thread a while ago.  Yes, all your emotions will come back if you avoid re-injuring your nervous system.  They will come back and feel very strong — fear and anger can be very strong and drive one to seek help.  Then, the doctors give more drugs which re-injure the system.  The dose of the drug is usually too high — too much for the fragile nervous system.  The doctors are always going to zero in on your “mental health” condition, and the chances that you will find one who will not make your condition worse are slim.

 

My emotions came and went with windows and waves.  It’s rare now that I am numb, and it only lasts for a few minutes or hours.  It’s also much less frequent that I feel slightly manic or depressed.  Everything has become less intense, less frequent, and more normal.  It happened very slowly, and it was not a linear process.  There were lots of ups and downs.  

The fact that recovery is not linear is the most perplexing and problematic part of the syndrome.  It is why people lose hope and go back to medication or drink or accept Xanax prescriptions. (Never add Xanax to your situation.  It is addictive within 2 weeks, and it would be the worst threat to your recovery.)  If you can come to terms with the fact that recovery is going to look as if you are having constant set backs, but persevere in the face of those set backs, you will recover.  It will take a long time, but it will be worth it.
 

Some people say that the good emotions come back later than the bad emotions.  I think that may have been true for me except for occasional swings into mania that I don’t have any longer.  These strange swings back and forth are very frequently misdiagnosed as bi-polar II.  The medication given for BP II exacerbates PAWS and patients end up “permanently” ill not because they are incapable of healing, but because the doctors do not know how to distinguish PAWS from true illness.  Neither do they recognize the side effects of medication as side effects.  They tend to see them as the emergence of new illnesses.  It seems incredible doesn’t it? More drugs will almost always hurt a person suffering from PAWS.  The doctors think ADs and APs cannot cause simple withdrawal or PAWS.  So, they end up causing WD or PAWS to worsen, and they kill people.
 

I have a very strong response to my monthly hormones, and PMS anxiety has been the most frustrating thing for me throughout this ordeal.  I think that my own hormones are poisoning me over and over.  So, if you are a woman, you should consider that any worsening of your condition may be related to hormones and is temporary.    You might feel much worse than previous PMS made you feel, but don’t mistake extreme PMS for a worsening condition overall.
 

It’s a mistake to drink alcohol - a major mistake.  Alcohol is extremely bad for a person suffering from withdrawal from other drugs.  (I would not, of course, suggest any illegal drug nor marijuana, legal or not.  Anything that messes with the brain is going to set back your healing.) Then, there are mistakes like adrenaline based numbing agents at the dentist.  You can ask for an alternative.  Do so.  Do not get a colonoscopy unless you absolutely must.  The drugs they will give you affect your brain.  You are going to have all kinds of aches and pains and odd symptoms.  Sometimes, searching for the cause results in re-injury depending upon the drugs the doctors use while investigating.
 

There might be unavoidable surgeries or accidents.  If you can, avoid doing anything that might cause an ER visit.  You don’t want to take any pain medication other than over the counter.  Prescription pain meds will set you back.  So, try to avoid injury.

 

Generally, the reason that people do not heal is because they make their conditions worse by drinking, taking drugs, CTing the AD instead of tapering very, very, very slowly or something out of their control makes their condition worse.  This isn’t permanent.  It just feels permanent.

 

I’m so sorry you have been caught up in this iatrogenic nightmare.  Good luck.

 

Rosetta

[Altostrata]

@Carolina, next steps depend on how you're feeling now, as yesyes asked.

[Shep]

On 2/11/2021 at 10:57 AM, Carolina said:

1) should I start tapering the Lexapro or Remeron? 

 

This thread can help answer this question:

 

Taking multiple psych drugs? Which drug to taper first?

 

If Remeron helps with sleep, you may want to taper it last unless you're getting a lot of side effects from it (overeating and weight gain, sleeping too much, having a hang over the next day, etc). 

 

20 mg of Lexapro is a very high dose because this drug is so potent. I'm going to leave the "tips for tapering off" for both your drugs. Even though you're not ready to taper, it may help to learn more about these specific drugs. 

 

Tips for tapering off escitalopram (Lexapro)

 

Tips for tapering off mirtazapine (Remeron)

 

On 2/11/2021 at 10:57 AM, Carolina said:

2) should I wait longer?

 

This post can help answer this question:

 

Withdrawal Normal

 

It's a great way of judging whether or not you're ready to taper. 

[Yesyes123]

Hey @Carolina how are you now?

[Carolina]

Hi @Yesyes123im doing well. Obviously very anxious and concerned over tapering and withdrawal but feeling well overall.

 

How are you doing? 

[Yesyes123]

@Carolina glad to hear.

 

I'm physically well but still so anxious and crying so much.

 

How long has it been since you reinstated?

[Carolina]

Have a bit of a quandary and would appreciate advice @Altostrata@Shep.

 

I have been tapering remeron. I decided to taper the remeron first because of: 1) side effects, and 2) the ‘limited’ ( 4 month) amount of time I have been on the drug when compared to the Lexapro ( which I have been on 7-8 years).

 

I am currently at 10 mg remeron and plan to hold here for 2-3 weeks. The taper, thus far, has been going smoothly. I have cut 20% this month.

My questions is: since I have been on the remeron for three/ almost four months do I follow  the 10% every four week rule?
 

The catch 22 I find myself questioning is based on the following ‘rationale’ ( only pertaining to medications that a person has been on less than a year or even six months) 

 

The slower I go on the taper, the longer I am on the remeron. The longer my body is  on the remeron, logically, the more it will adjust or become addicted to this drug and, therefore, the harder it will be to come

off it ( the longer and more difficult withdrawal sill be). 
 

 

Would you recommend trying a more aggressive taper ( meaning 20% a month, nothing too agressive) for someone who has been on the drug a shorter time to diminish the overall length one is exposed to a drug??

[Altostrata]

Carolina, does the Remeron help you sleep? Is that why you started it in December?

 

No, taking it for only 4 months does not mean you can quickly go off it now. Most likely, going off quickly will cause the insomnia to re-emerge. 

 

Adverse effects of Remeron should decrease as you decrease the dosage. What adverse effects do you feel now?

 

If you were taking it for withdrawal insomnia and you intend to taper Lexapro, if I were you, I'd stop tapering Remeron at perhaps 7.5mg, let your system settle for a bit, and then start tapering Lexapro by 10% per month per Tips for tapering off escitalopram (Lexapro)

 

If you keep taking the Remeron while you're tapering Lexapro, it may assist in your taper by enabling you to sleep. You would finish tapering Remeron later.

[Carolina]

Thank you @Altostrata

 

Just very disheartening that it will take 5-6 years to come off a drug I’ve been on for four months.

 

[JesusSavemefromWD]

50 minutes ago, Carolina said:

Have a bit of a quandary and would appreciate advice @Altostrata@Shep.

 

I have been tapering remeron. I decided to taper the remeron first because of: 1) side effects, and 2) the ‘limited’ ( 4 month) amount of time I have been on the drug when compared to the Lexapro ( which I have been on 7-8 years).

 

I am currently at 10 mg remeron and plan to hold here for 2-3 weeks. The taper, thus far, has been going smoothly. I have cut 20% this month.

My questions is: since I have been on the remeron for three/ almost four months do I follow  the 10% every four week rule?
 

The catch 22 I find myself questioning is based on the following ‘rationale’ ( only pertaining to medications that a person has been on less than a year or even six months) 

 

The slower I go on the taper, the longer I am on the remeron. The longer my body is  on the remeron, logically, the more it will adjust or become addicted to this drug and, therefore, the harder it will be to come

off it ( the longer and more difficult withdrawal sill be). 
 

 

Would you recommend trying a more aggressive taper ( meaning 20% a month, nothing too agressive) for someone who has been on the drug a shorter time to diminish the overall length one is exposed to a drug??

Carolina please don’t make the same mistake I made . I was on the lowest subtherapeutic dose of Zoloft (which I think is milder of a drug compared to remeron) for just 3&1/2 WEEKS, and did an additional 4&1/2 weeks taper reducing 5mg/week. Every week I reduced I suffered bad WD symptoms but kept tapering thinking exactly what u said “ the faster I quit the more likely to get free of this drug”. That doesn’t mean u ll face the same difficulties as me, u know it’s a very individual thing, but my point is start ur slow taper and listen to ur body in order to determine the rate of tapering. As u taper if no bad WD continue tapering, maybe u can speed the tapering again with caution, but if bad WD symptoms appear hold longer or increase slightly. I am 4 months completely off Zoloft and suffer mentally a lot, I have greatly regretted tapering fast, not listening to my body but to my brain telling me do it fast not to get stuck with the drug. That’s just my experience. Good luck to you.

[Carolina]

Thank you @JesusSavemefromWD. I truly appreciate your input. I’m so sorry you are going through/ have gone through this terrible ordeal. 
 

[Carolina]

At 10 mg remeron. Will stay here for a month.

 

Notice a slight uptick in irritability and fatigue.  All manageable. Sleep is still good. 
 

i hope the taper of remeron continues smoothly. 
 

 

[Carolina]

Notes to myself. I have a strong impulse to cold turkey as of late as I now understand how detrimental  these medications are but I have to remind myself of:

 

1)The risks/ rewards : I can’t go back in time. If I could, I would never touch these poisons. There is no do over.  I can only go forward. The risks of the effects of a CT far outweigh the rewards of being drug free quickly. There is no ‘CTing’ without serious WD for me. You learned this lesson once. Learn from your mistake.
 

Einstein said insanity is ‘ trying the same thing over and over again and expecting a different result’. You are not insane. 

 

2) By tapering slowly you gain

more control over the process and these medications.
 

The idea of having control by CTing is a mirage. By being able to catch WD symptoms early and have the possibility to upside, stop for a while or taper even more slowly, I gain more control of the process , my body and these medications.

 

CTing relinquishes any ‘control’ you have in this process.

 

Patience is a virtue I have always admired but rarely have ever had. Patience Carolina. One day at a time. 

 

 

[JesusSavemefromWD]

Yes please go slowly.... I wish someone had told me that ....now I am four months off Zoloft and I am so bad my only choices are reinstaining but it’s risky or trying another med in the hopes to counteract Zoloft side effects which I doubt it will.

if u don’t mind me asking , when u reinstated lexapro, how long was it after u had stopped and how fast did u start feeling better after restarting lexapro and did u restart on the dose u had stopped?

thanks 

[Altostrata]

Carolina, my point is if Remeron is helping you sleep, you'll want to stay on it until you're off Lexapro. 7.5mg Remeron may be sufficient to support your sleep. Lower dosages mean lower adverse effects, which will be true throughout your taper.

 

Going off will take as long as it takes. Millions of people are in the same situation as you. Please don't blame yourself, actively forgive yourself for your past decisions. It wasn't your fault.