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On mini-tapering or micro-tapering


Onmyway

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Recently I have been doing some micro-tapering - this is even slower than the Brassmonkey slide method - I went at 0.5% every week to 10 days. The issue was that instead of not feeling much, I was feeling quite intense symptoms and they would last for a week or two at which point I would drop again. These symptoms were not very different from the larger drops that I had made though the physical issues were lacking, it was mostly psychological rumination/OCD-like anxiety/insomnia/muscle tightness/agitation. I did not have nausea and dizziness. 

 

I am worried that at this rate of tapering I will just end up suffering much longer than if I do slightly larger drops (still under 10% a month). 

 

This Horowitz and Taylor paper advises a mini-taper rather than a micro-taper

 

"Some practical consequences of these principles The model proposed also resolves a quandary often raised by patients and treating physicians: whether to ‘micro-taper’ or ‘mini-taper’. ‘Micro-tapering’ involves miniscule decrements in SSRI medication every day or week. ‘Mini-tapering’ involves step-wise larger decrements, with longer intervals in between decrements (generally, weeks). ‘Minitapering’ appears more sensible than ‘micro-tapering’ (although both are linear methods). 10 Withdrawal symptoms are reported to last for several weeks (or longer) after medication discontinuation in a significant proportion of patients 9,13. Given this pattern, ‘microtapering’ presents the possibility of cumulative withdrawal effects superimposing upon one another. This would make it difficult to establish which reduction (or set of reductions) were responsible for symptoms experienced. It therefore seems prudent to decrease the dose of medication, allow a significant period of time to elapse while withdrawal effects resolve, before commencing the next decrement."

 

Horowitz_Taylor_A_method_of_tapering_SSRI_treatment_to_mitigate_withdrawal_symptoms.pdf (kcl.ac.uk)

(this is an open access version of the Lancet paper, I think)

 

I wonder if anyone has an opinion on this? 

@brassmonkey how did you choose to do your micro-taper and did you experiment with others? 

 

If you would like to get a response from me directly please type @Onmyway some place in your message so I get notified of your post. I am not able to follow all of the threads all the time.

 

Aug  2000 - July 2003 (ct, 4-6 wk wd) , citalopram 20 mg,  xanax prn, wellbutrin for a few months (don't remember dates), trazodone prn 

Dec 2004 - July 2018 citalopram 20 mg, xanax prn (rarely used)

Aug 2018 - citalopram 40 mg (self titrated up)

September 2018 - January 2019 tapered citalopram - 40/30/20/10/5 no issues until a week after reaching 0

Feb 2019 0.25 xanax/day, then 0.5/day (3 weeks) over to klonopin 0.25 once a day to manage severe wd

March 6, reinstated citalopram 2.5 mg (liquid), klonopin 0.25 mg for sleep 2-3 times a week

Apr 1st citalopram 2.0 mg (liquid), klonopin 0.25 once a week, 

citalopram (liquid) 4/14/19 -1.8 mg, 5/8/19 - 1.6 mg,  7/2719 -1.5 mg,  8/15/19 - 1.35, 2/21/21 - 1.1 (smaller drops in between), 6/20/21 - 1.03 mg, 8/7/21- 1.025, 8/11/21 - 1.02, 8/15/21 - 1.015, 9/3/21 - 0.925 (fingers crossed!)

Supplements: magnesium citrate and bi-glycinate

 

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brassmonkey

The art of tapering ADs is ever changing as we learn new information about how they actually work and gain more experience in tapering . When I started my taper just over ten years ago the 10% every four weeks rule was fairly new and just being tried out. What I was able to find out made sense to me, but I didn't like the fact that it hit a person with a heavy symptom load a day or two later.  One of my prime concerns was to remain as functional as possible being the sole provider for my family. Thinking it through I came up with the idea of splitting up the reductions to help reduce the shock. Then added on a hold to let things settle down before doing it again.

 

I was tapering out of a very strong tachyphylaxis, so it was quite hard to gage things at first. You have to overcome the tolerance before the reductions make any headway symptom wise. But I was not hit with a strong symptom load with each reduction, which is what I was after. This method worked well for me so I used it for my entire taper. I did have to modify it a bit for the Endgame because of the limitations of my scales. 

 

The tapering style a person uses is up to their situation. It is always best to start very conservatively and modify as one goes. However, you need to keep the limits in mind. We have proved time and again that 10% every four weeks is about as fast as is safe to taper. Any attempt to go faster or larger invariably ends in a crash. This forces the person to stop tapering, adjust their dose, and stabilize for what could be many months before continuing to taper.

 

I find that in most cases microtapers are tedious and unnecessary. There are individuals that are overly sensitive to the reductions and need to do microtapers, but they have to find out by experimentation if that is the case. I have found over the years that a Brassmonkey Slide or one that has been modified to use smaller reductions is the most effective way to reduce. We have a large and growing membership that are using it successfully.

20 years on Paxil starting at 20mg and working up to 40mg. Sept 2011 started 10% every 6 weeks taper (2.5% every week for 4 weeks then hold for 2 additional weeks), currently at 7.9mg. Oct 2011 CTed 15oz vodka a night, to only drinking 2 beers most nights, totally sober Feb 2013.

Since I wrote this I have continued to decrease my dose by 10% every 6 weeks (2.5% every week for 4 weeks and then hold for an additional 2 weeks). I added in an extra 6 week hold when I hit 10mg to let things settle out even more. When I hit 3mgpw it became hard to split the drop into 4 parts so I switched to dropping 1mgpw (pill weight) every week for 3 weeks and then holding for another 3 weeks.  The 3 + 3 schedule turned out to be too harsh so I cut back to dropping 1mgpw every 4 weeks which is working better.

Current dose 0.000mg 04-15-2017

 

"It's also important not to become angry, no matter how difficult life is, because you can loose all hope if you can't laugh at yourself and at life in general."  Stephen Hawking

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