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davoid: How I Measure My Doses


davoid

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Hi everyone,

                      I have recently started taking anti-depressants for depression and anxiety. I was already thinking about tapering off completely and I found this forum. 

  I saw lots of info on tapering, but I thought I'd share how I measure my doses in case it helps anyone.

First a little background: I have had Chronic Fatigue Syndrome/Fibro Myalgia since around 1997 due to a giardia infection left untreated for 3 years.

I started on Traditional Chinese Medicine in 1997, which I took every day for 2.5 years. I recovered to a great extent from the infection, but the CFS/FM stayed.

  I lived in a public housing building for 20 years, which caused a lot of the depression, and most of the anxiety.

I was transferred to a low density unit in 2019, but the anxiety has remained.

  I am sensitive to most things due to the CFS/FM, so when I tried my 2nd AD (stopped 1st one after 2 days due to side effects), I told the GP (doctor) I wanted to try a low dose. The tablets are 20 mg, and I wanted to try 5 mg.

  The tablets are dispersible so I have used a water suspension/solution, and a 0.01 g digital scale.

A 0.01 g scale can measure e.g. 10.01 g. Most kitchen scales are 0.1 g, (e.g. 10.1 g) so not as accurate for light objects.

 

Here's how I did my dosage:

 

20 mg divided by 4 = 5 mg

weight of tablet = 0.24 g

weight of 1 ml = 1 g

small bottle approx. 60 ml capacity

40 ml of water (10 ml per dose)

eyedropper for small changes to liquid

small plastic measuring cup (5-20ml) 

 

1. Put the empty bottle on scale

2. Press 'Tare' which resets the scale to zero

3. add water to approx. level at tap

4. place bottle on scale to see weight

5. use measure cup and eyedropper to get weight to 39.76 g (39.76 ml)

6. add 20 mg tablet (0.25 g) to bottle

7. bottle now weighs 40.00 g (40 ml)

8. shake bottle, leave till next dose (usually overnight)

 

To get a dose of 5 mg:

 

1. shake bottle well

2. place measuring cup on scale

3. press 'Tare' to reset to zero

4. add liquid from bottle to measuring cup to approx. 10 g 

5. use eyedropper to adjust to 10 g

6. put approx. 40 ml of water in another glass/cup

7. fill measuring cup to 20 ml approx. with water from 2nd glass/cup

8. pour measure cup into glass/cup

9. drink glass/cup with liquid approx. 60 ml

 

Notes:

 

1. Mixing the extra water from the 2nd glass/cup helps to get all of the medication from the measuring cup,

    as 10 g (10 ml) is such a small amount.

2. For the last dose, as it's hard to get every last drop from the glass bottle, I add approx. 60 ml of water

    to the bottle, shake well, and then pour into glass to drink.

   If this isn't done the last dose can be reduced by approx. 0.15-0.2 g, so if 10 g is the weight required, 

   it will be 9.80-9.85 g instead, which for a 5 mg dose means a reduction to 4.90-4.93 mg. 

    Not a huge difference, but if the dose is smaller, it gets more pronounced.

 

After 2 weeks I reduced my dose from 5 mg to 4 mg, as I wanted to find the lowest dose I needed. 

After 20 days on 4 mg I reduced to 3.5 mg, but felt worse, so after 2 days I returned to 4 mg, which I've been on for the last 7 days.

 

To get the 4 mg dose I altered the weight of each dose from 10 g to 8 g with the same 40 g of water/tablet.

 

To get the 3.5 mg dose it was 7 g.

 

I reduced from 5 mg to 4 mg also due to the side effects. 4 mg felt better to me. Sleep was better.

 

The reason I have been thinking of tapering off the AD medication are due to the side effects:

 

memory problems

lack of clear awareness, e.g. driving, doing simple tasks

trouble getting to sleep

frequent waking from sleep (more than usual)

tinnitus (more than usual)

sensitivity to noise (more than usual)

tight jaw muscles (more than usual)

numbness in thigh (trigger points are normal numbness isn't)

closed eye visualisations have changed from the usual*

unusual dreams

not feeling 'myself'

tiredness

feeling sleepy for no reason

 

* closed eye visualisations (or closed eye hallucinations) are what some people see when there eyes are closed and in a relaxed state. I noticed on the 1st AD medication that the usual patterns where all chunky and artificial looking, plus I had faint images changing rapidly like a fast movie without any thoughts.

The 2nd AD medication has also changed the CEVs, but less harshly. I have noticed a clear geometric pattern sort of embedded in the usual shapes that I see.

 

Overall I have had less anxiety, and less depression, but I don't like feeling slightly detached from life. Not a zombie exactly, but I just feel like I'm zoning out at times. Example: I went to take some sweet potato pieces from the freezer, but I took out butternut pumpkin (squash) instead, but didn't realise. The pumpkin hadn't been used for a while, so it had iced up. So I'm removing the ice, and laying the pieces out to dry, and then I realised what I was doing. I thought the pumpkin was sweet potato.

It's like my brain just didn't register. They are similar, but I should have realised much sooner.

  It's not a huge deal, but I don't like it.

 

Anyway, I hope this info helps someone.

 

St John's Wort - 300 mg - daily - April 2011 to 29-Nov-2020

Seremind - lavender capsules - daily - 15-Jun-2019 to 31-Dec-2020

Chinese granule herbs - 4 g - daily - 4-Mar-2020

Supplements: magnesium 133 mg x 4, calcium 315 mg, Vit C 250 mg x 10, Vit D 250 IU, Vit B complex, iron, zinc, chromium, brewer's yeast, molasses, sulfur (MSM), milkthistle, iodine, glucosamine 1000 mg, melatonin 1.5 mg, selenium, maca powder, banana flour, olive leaf extract, bromelain enzyme, digestive enzymes x 8-9 daily.

Valium - 0.5 mg to 1 mg - once or twice per month, or less - 2019 to Nov-2020 

Cymbalta - 30 mg - daily - 30-Nov-2020 to 1-Dec-2020

Prozac - 5 mg - daily - 10-Dec-2020 to 22-Dec-2020

Prozac - 4 mg - daily - 23-Dec-2020 to 13-Jan-2021

Prozac - 3.5 mg - daily - 14-Jan-2021 to 15-Jan-2021

Prozac - 4 mg - daily - 16-Jan-2021 to 21-Jan-2021

Prozac - 1%/day taper from 4mg - 22-Jan-2021

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  • manymoretodays changed the title to davoid: How I Measure My Doses
  • Moderator Emeritus

Hi, Davoid.

 

Welcome to Surviving Antidepressants. 

 

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

 

On 1/20/2021 at 7:43 AM, davoid said:

After 2 weeks I reduced my dose from 5 mg to 4 mg, as I wanted to find the lowest dose I needed. 

After 20 days on 4 mg I reduced to 3.5 mg, but felt worse, so after 2 days I returned to 4 mg, which I've been on for the last 7 days.

 

It looks like you're reducing too fast. Going from 5 mg to 4 mg is a 20% reduction. We recommend reducing no more than 10% based on the prior month's dose (not the original dose). Please see:

 

Why taper by 10% of my dosage?

 

Please let us know about your drug history and any supplements or herbal remedies you're taking.

 

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.

 

 

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Hi Shep,

 

thanks for the reply and info.

 

re: 5mg to 4mg

this was after only 13 days, so it didn't have any noticeable effect, but the reduction from 4mg to 3.5mg was after a further 20 days on 4mg, so there was an effect (agitation).

 

I have started a 1% per day taper as of 22-Jan-2021 from 4mg.

 

More info:

 

St John's Wort - I've been taking 300mg a day since 2011. I stopped this before taking ant-depressants due to the interaction.

Seremind - Lavender oil capsules - started taking these  15-Jun-2019. 1 capsule/day. I stopped these 31-Dec-2020.

Chinese medicine herbal granules - I take 4g/day. Started this 4-Mar-2020.

I take a lot of vitamins/minerals for my CFS/FM: magnesium, calcium, Vit C, Vit D, Vit B complex, iron, zinc, chromium, brewer's yeast, molasses, sulfur (MSM), milkthistle, iodine, glucosamine, melatonin, selenium, maca powder, banana flour, olive leaf extract, bromelain enzyme, digestive enzymes x 8-9 daily.

 

Anti-depressants:

 

Cymbalta 30mg - started 30-Nov-2020. Stopped 2-Dec-2020. Due to side effects.

 

Prozac 20mg - told doctor I'd like to try a low dose. He recommended 5 mg for 2 weeks, then 10 mg.

10-Dec-2020 - started on 5mg/day in morning.

23-Dec-2020 - reduced to 4mg/day. Side effects (sleep).

14-Jan-2021 - reduced to 3.5mg/day. Side effects (sleep).

16-Jan-2021- increased to 4mg/day. Side effects (agitation).

22-Jan-2021 - started 1%/day taper from 4mg. Reason: side effects.

 

I added this info to my signature.

 

re: Tapering 10% per 4 weeks

I don't really want to take 40 weeks to get off. I'm hoping that the low dose combined with the short length of time on it, that it will be manageable, but time will tell.

So far the main side effect is my tinnitus is worse than usual. This could be related to my jaw muscles and their effect on my ears, as the muscles seem to be tighter than usual.

On Cymbalta I had constant 'yawning' that lasted hours during the day. On Prozac I am yawning more during the day than usual, but much less than Cymbalta.

I did have some insomnia on 23-Jan-2021, with tinnitus, so had to get up for 2 hours at 3am. Due to my CFS/FM I can get dehydrated easily due to body temperature problems, and it is summer here.

St John's Wort - 300 mg - daily - April 2011 to 29-Nov-2020

Seremind - lavender capsules - daily - 15-Jun-2019 to 31-Dec-2020

Chinese granule herbs - 4 g - daily - 4-Mar-2020

Supplements: magnesium 133 mg x 4, calcium 315 mg, Vit C 250 mg x 10, Vit D 250 IU, Vit B complex, iron, zinc, chromium, brewer's yeast, molasses, sulfur (MSM), milkthistle, iodine, glucosamine 1000 mg, melatonin 1.5 mg, selenium, maca powder, banana flour, olive leaf extract, bromelain enzyme, digestive enzymes x 8-9 daily.

Valium - 0.5 mg to 1 mg - once or twice per month, or less - 2019 to Nov-2020 

Cymbalta - 30 mg - daily - 30-Nov-2020 to 1-Dec-2020

Prozac - 5 mg - daily - 10-Dec-2020 to 22-Dec-2020

Prozac - 4 mg - daily - 23-Dec-2020 to 13-Jan-2021

Prozac - 3.5 mg - daily - 14-Jan-2021 to 15-Jan-2021

Prozac - 4 mg - daily - 16-Jan-2021 to 21-Jan-2021

Prozac - 1%/day taper from 4mg - 22-Jan-2021

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  • Moderator Emeritus
11 hours ago, davoid said:

re: 5mg to 4mg

this was after only 13 days, so it didn't have any noticeable effect, but the reduction from 4mg to 3.5mg was after a further 20 days on 4mg, so there was an effect (agitation).

 

I have started a 1% per day taper as of 22-Jan-2021 from 4mg.

 

It takes about a month to develop a dependency on an antidepressant. However, because you were taking St John's Wort from 2011 to November 2020, you may have developed a dependency to that, which also increases serotonin. So you may be more dependent than if you had never used this supplement. We recommend people taper off of St. John's Wort because it acts so similarly to an antidepressant and can have similar withdrawal symptoms.  

 

For more information, please see:

 

St. John's Wort (Hypericum Perforatum)

 

I would not taper 1% per day off the Prozac, as that's 30% a month. Way too fast, especially since you noticed agitation from the last reduction. That's a sign of dependency and a too-fast taper. 

 

Please note that antidepressants are known for a delayed withdrawal syndrome, meaning you may not feel the full effects of withdrawal for several months after coming off. This is why we recommend a slow taper because that reduces the chances you'll be hit with more severe symptoms down the road. 

 

Let your symptoms guide your taper for best results. 

 

11 hours ago, davoid said:

I take a lot of vitamins/minerals for my CFS/FM: magnesium, calcium, Vit C, Vit D, Vit B complex, iron, zinc, chromium, brewer's yeast, molasses, sulfur (MSM), milkthistle, iodine, glucosamine, melatonin, selenium, maca powder, banana flour, olive leaf extract, bromelain enzyme, digestive enzymes x 8-9 daily.

 

 

Some of these may cause upticks in symptoms. You can use the search feature or google "surviving antidepressants" + [name of supplement]" and find more information. B vitamins and vitamin D especially can make people anxious or worsen insomnia if their nervous system is destabilized from withdrawal. Some people are fine on it, but some find it's best to eat foods high in B and D vitamins instead of taking supplements. Vitamin D can also be obtained by safe sun exposure. 

 

You're listed very minor symptoms so far, which is great. For that reason, I would recommend going no faster than 10% a month (based on the prior's month's dose, not the original dose) so you can feel as good as you can all the way through your taper and afterwards. 

 

Two more questions: 

 

  • How is your sleep? 
  • When did you develop CFS/FM? 

 

 

 

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Hi Shep,

 

thanks for the reply and info.

 

re: Tapering

I might stay on my current dose for a couple of days, and then resume, and repeat.

I don't want to do 10% a month, as it's too long.

 

re: Vitamins/minerals

I am pretty conservative taking supplements. I use liquid minerals, so I can have smaller doses, etc.

If something doesn't make a difference, or makes thing worse, I stop taking it, or reduce the dose.

 

Re: Sleep

Since I started to taper off it's improved. I've only had one insomnia event, and that was related to being hot/dehydrated.

 

Re: CFS/FM
I started on daily antibiotics around 1983 (15 y.o.) for severe acne, and stayed on them until I tapered off just before travel overseas in 1994.
I went to Nepal in May 1994 for about 2 weeks and ate something that made me a little bit ill.

When I got to London I woke up one morning with stomach cramps (which I'd never had before).

Went to local GP (doctor), gave a sample, which came back negative, which with Giardia is common.

  Continued on my travels, but didn't feel myself. Returned to Australia August 1994, and had occasional 'Giardia attacks' (that's what I call them) after eating, but didn't see a doctor. 

I saw a naturopath for a couple of months for tiredness, and cold like symptoms in 1996.

  By June 1997 I was very sick, and started treatment with Traditional Chinese Medicine, which I continued until late 1999.

When winter 2000 came around, I got unwell again, and resumed TCM for a few months.

By 2002, I realised I was struggling in cold seasons, and did some research online, and found I had CFS.

I've had ups and down since then, and some improvements here and there, but the underlying condition won't resolve.

The FM I added after years of muscle/joint problems. CFS and FM sort of blend together often.

  I think the anxiety and depression have stemmed from the CFS/FM. CFS affects the hormone systems, which control so many things. So if the hormones are 'out of whack' you are in trouble. My body temperature regulation doesn't work properly. I think a lot of CFS is related to the heart. My heart doesn't beat deeply enough, so it can't push the blood to the extremities. So, cold hands, cold feet, ankles. calves.
  Giardia is a cold water creature. So it makes it's host's body suit it's environment: cold.

 

St John's Wort - 300 mg - daily - April 2011 to 29-Nov-2020

Seremind - lavender capsules - daily - 15-Jun-2019 to 31-Dec-2020

Chinese granule herbs - 4 g - daily - 4-Mar-2020

Supplements: magnesium 133 mg x 4, calcium 315 mg, Vit C 250 mg x 10, Vit D 250 IU, Vit B complex, iron, zinc, chromium, brewer's yeast, molasses, sulfur (MSM), milkthistle, iodine, glucosamine 1000 mg, melatonin 1.5 mg, selenium, maca powder, banana flour, olive leaf extract, bromelain enzyme, digestive enzymes x 8-9 daily.

Valium - 0.5 mg to 1 mg - once or twice per month, or less - 2019 to Nov-2020 

Cymbalta - 30 mg - daily - 30-Nov-2020 to 1-Dec-2020

Prozac - 5 mg - daily - 10-Dec-2020 to 22-Dec-2020

Prozac - 4 mg - daily - 23-Dec-2020 to 13-Jan-2021

Prozac - 3.5 mg - daily - 14-Jan-2021 to 15-Jan-2021

Prozac - 4 mg - daily - 16-Jan-2021 to 21-Jan-2021

Prozac - 1%/day taper from 4mg - 22-Jan-2021

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  • Moderator Emeritus
5 hours ago, davoid said:

re: Tapering

I might stay on my current dose for a couple of days, and then resume, and repeat.

I don't want to do 10% a month, as it's too long.

 

The 10% rule is a harm-reduction rule. Please note your earlier experience:

 

On 1/20/2021 at 7:43 AM, davoid said:

After 2 weeks I reduced my dose from 5 mg to 4 mg, as I wanted to find the lowest dose I needed. 

After 20 days on 4 mg I reduced to 3.5 mg, but felt worse, so after 2 days I returned to 4 mg, which I've been on for the last 7 days.

 

Prozac has a very long half life, so if you experienced withdrawal after only 2 days when you still had the majority of the drug in your system, then you may be more dependent on this drug than you think. 

 

I would caution against rushing this, especially since you have another medical condition that has similar symptoms (many people develop CFS due to the use of SSRIs). 

 

Also, you were on St Johns Wort for nearly 10 years before switching to an antidepressant. 

 

5 hours ago, davoid said:

Re: Sleep

Since I started to taper off it's improved. I've only had one insomnia event, and that was related to being hot/dehydrated.

 

I'm glad to read your insomnia is improving. 

 

Let us know how you're doing as you taper. But again, I would urge caution against rushing this. The goal is to be as functional as possible throughout your taper. 

 

 

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  • 2 weeks later...

I stopped the 1% per day taper on the 30-Jan because of tinnitus. I've had tinnitus for years, but this wasn't normal.

It's fairly constant. It does go down after eating, but returns later.

 

I decided to stay at 3.6 mg (31-Jan) for a few days to see how it went.  By the 4-Feb the tinnitus had lessened, so I started a 0.5% per day taper on 5-Feb from 3.6 mg.

 

I still have the tinnitus, but it's not as bad as before, so I am continuing on.

 

It's 13-Feb today, and I am at 3.42 mg dose.

St John's Wort - 300 mg - daily - April 2011 to 29-Nov-2020

Seremind - lavender capsules - daily - 15-Jun-2019 to 31-Dec-2020

Chinese granule herbs - 4 g - daily - 4-Mar-2020

Supplements: magnesium 133 mg x 4, calcium 315 mg, Vit C 250 mg x 10, Vit D 250 IU, Vit B complex, iron, zinc, chromium, brewer's yeast, molasses, sulfur (MSM), milkthistle, iodine, glucosamine 1000 mg, melatonin 1.5 mg, selenium, maca powder, banana flour, olive leaf extract, bromelain enzyme, digestive enzymes x 8-9 daily.

Valium - 0.5 mg to 1 mg - once or twice per month, or less - 2019 to Nov-2020 

Cymbalta - 30 mg - daily - 30-Nov-2020 to 1-Dec-2020

Prozac - 5 mg - daily - 10-Dec-2020 to 22-Dec-2020

Prozac - 4 mg - daily - 23-Dec-2020 to 13-Jan-2021

Prozac - 3.5 mg - daily - 14-Jan-2021 to 15-Jan-2021

Prozac - 4 mg - daily - 16-Jan-2021 to 21-Jan-2021

Prozac - 1%/day taper from 4mg - 22-Jan-2021

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  • Moderator Emeritus
On 2/12/2021 at 5:02 PM, davoid said:

I decided to stay at 3.6 mg (31-Jan) for a few days to see how it went.  By the 4-Feb the tinnitus had lessened, so I started a 0.5% per day taper on 5-Feb from 3.6 mg.

 

A 0.5% per day taper is 15% per month, which is still too fast. I would slow down to no faster than 10% per month. With Prozac's long half-life, by the time symptoms show up, it may be too late to hold or updose to relieve your symptoms. 

 

However, if you're not here for tapering advice but simply to give updates, I'll stop responding to your posts as I don't want to waste my time or yours repeating the same information. 

 

 

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