Jump to content
SurvivingAntidepressants.org is temporarily closed to new registrations until 1 April ×

Brassmonkey's Tips and Tricks for Tapering


brassmonkey

Recommended Posts

  • Moderator

Brassmonky’s Tips and Tricks for Tapering

 

In an effort to keep the article “Managing the Endgame Taper” to a manageable size I am creating this thread to supply more specific information on how to work with the various topics. I will also be using it to draw together bits of specific tapering information drawn from my experience and observations, that are scattered throughout the site. This will be an ongoing eclectic work broken into many sections dealing with many topics.

 

ACRONYMS AND DEFINITIONS

Throughout the various articles and posts I have written there are a number of terms used that require further explanation. Having been a technical writer for many years I have found that creating a descriptive term for a subject or process can greatly help in getting the idea across to the people learning about it. Some of these terms are ones I have made up for this purpose or to help clarify communication where one term can have several meanings, while others are scientific terms with common usage.

Because both weight and strength are measured in milligrams it is easy to confuse them. We add the MGAI and MGPW designations when discussing our doses so we can tell which number we are talking about. We use MGAI when talking about what dose we are taking but use MGPW to weigh out that dose on the scales when dry-cutting. Both of these measurements need to be recorded in your notes.

MGAI Milligrams Active ingredient, this is the strength of the drug in a single dose. It is in your prescription and is listed on the packaging. For example, I was taking 40mg Paxil at the start of my taper. 40 milligrams is the amount of active ingredient in each tablet. As we taper this number decreases with each reduction. The MGAI is also part of the strength designation for liquid preparations. It is listed as a ratio of Mg/mL.

MGPW Milligrams Pill Weight, this is the physical weight of the full tablet or the weight of the powder for a reduced dose as measured on the scales. It is different from the MGAI because each manufacturer adds fillers to make the pills.

The MGAI and the MGPW are proportional to each other. By making a change to one of them the same change is automatically made to the other. If we reduce the weight of the dose (MGPW) that we weigh on the scale by 10% then the strength of the dose (MGAI) is also decreased by 10%.

AIC, Active Ingredient Concentration, is the ratio of Active Ingredient to Pill Weight. It is calculated by dividing the MGAI by the MGPW. This will tell us how much Active Ingredient is in 1milligram of pill/powder. For working with liquids this is called the Dilution Ratio.

I used 40MGAI (Milligrams Active Ingredient) Paxil tablets that weighted 500MGPW (Milligrams Pill Weight) for my entire taper. Using the above formula, we get:

40MGAI / 500MGPW = 0.08MGAI/MGPW

 

As another example, Sertraline can come in 100MGAI tablets that weigh 311MGPW. That would give an entirely different AIC.

100MGAI / 311MGPW = 0.3 MGAI/MGPW

It is important to note that the AIC must be calculated for on an individual basis for the pills that are being used at that time for the taper. This is because there are differences between manufacturers and pill sizes that could lead to the dose being miscalculated if a different pill is used. A 40MGAI Paxil tablet from one manufacturer may weigh 500MGPW, but from a different manufacturer could be a different weight, and that would change the AIC.

 

Dilution Ratio The amount of active drug ingredient in a specific volume of liquid. Usually expressed as Mg/mL (milligrams per milliliter), it is listed on the packaging and calculated when making up solutions. This is the liquid equivalent of the AIC.

Dose Strength The amount of active ingredient in a single dose of drug. Usually expressed as MGAI (Milligrams Active Ingredient).

Dry-Cutting Splitting, cutting up a tablet or crushing it and weighing the powder for a dose – no liquid involved.

Liquid taper Tapering by using a liquid suspension or solution, commercially available, from a compounding pharmacy, or do-it-yourself.

Measured Dose Volume The specific amount of liquid drug taken for each dose. It is measured in mL (milliliters) using a syringe or dropper.

Target Exit Dose Is the dose to aim for before making the jump to “0”.  

 

 

Theoretical Exit Dose

The Theoretical Exit Dose is the dose to aim for before making the jump to “0”.  Some people think that a person should just taper as far as possible and then jump to “0”. However, one of the most frequently questions I get is “when do I make the jump?”. People need a target so they can make plans and chart progress.

This is where the Theoretical Exit Dose comes into play. First off it is not a hard and fast number, but rather a point in the taper where it is most likely a person can make the jump to “0” and experience a minimum of WD symptoms.

 

It is defined by Horowitz & Taylor, 2021 and Horowitz, et al.2021, as 1% SERT receptor occupancy which usually works out to be about 1mg. In my experience this is still much too large a dose for most people to make a smooth transition to zero.  If the transition does not go smoothly then reinstatement, stabilization and continued tapering are required.  Which can greatly lengthen an otherwise smooth taper.

 

I prefer to use the formula (median prescribed dose X 0.000625 = Theoretical Exit dose). Most medications are prescribed over a range of doses. For example, paxil comes in 20, 30, and 40 milligram doses. The median dose would be 30mg, which would be used in the formula above. Because we calculate using the median prescribed dosage this formula takes into account the differences in strength between medications and can be used with any of the different psych medications we see.

Again, this is a theoretical dose, something to aim for but not necessary to hit. The actual jump point is determined by how your body is reacting to your reductions.

 

 

 

                                    WORKING WITH LIQUID TAPERS

 

WARNING NOTE

In general, you will not be able to make a liquid from an extended-release drug. Either the drug will be destroyed in a liquid or the glue in the tablet will create a gum. You can make a homemade liquid with immediate-release drugs only. (The only exception is the type of venlafaxine XR in capsules filled with tiny beads – the beads can be dissolved in liquid.)

 

 

As your taper continues, you will find the volume of your dose becomes smaller and smaller until it can become quite difficult to measure even if you use the smallest oral syringe. With the help of a little math and different syringe sizes it is possible to fine-tune a reduction to a very tiny amount using liquids. Altering the Dilution Ratio can give you even finer control to measure out the tiniest doses with an oral syringe.

 

Changing the dilution ratio to make the liquid easier to measure

 

Adjustments in the dilution ratio can be made to any liquid, homemade, commercial, or compounded. Why would you want to make a liquid weaker? By adding water or pharmacy base liquid or other dilutant to your drug, you add volume to a dose. If you could not take 0.10mg because your oral syringe could not measure a small enough amount, increasing the volume while keeping the amount of drug the same – a weaker dilution -- will enable you to measure the tiny dose.

The Dilution Ratio is the strength of the drug in milligrams of active ingredient (mgai) divided by the volume of liquid in milliliters (mL). This works for both suspensions and solutions.

For example: if a person is using 20mg citalopram tablets and dissolves one tablet in 20mL of water, the resulting liquid is in a 1:1 Dilution Ratio:

 

- 20MGAI per 20mL of liquid is the same as - 1mgai in 1mL of liquid.

 

To take 0.50mgai, you would take 0.50mL of the liquid. To take 0.1mgai, you would take 0.1mL of the liquid, or one 1/10 of a 1mL oral syringe.

The 1:1 Dilution Ratio liquid is the easiest to work with because any change in volume causes the same change in dose strength. Using 1mL of this liquid gives a dose of 1mgai. Reducing the volume by 10% to 0.9mL also decreases the dose strength by 10% to 0.9mgai.

If we were to use a 20mg tablet and double the volume of the dilutant to 40mL to make up the batch, we would get a Dilution Ratio of 1:2:

 

- 20mgai per 40mL of liquid is the same as 1mgai in 2mL of liquid.

 

To take 0.5mgai, for example, you would take 1mL of the liquid. To take 0.10mgai, you would take 0.2mL of the liquid.

If you’re tapering a very low dose by 10%, such as 0.21mgai citalopram, you may wish to make an even higher Dilution Ratio to avoid attempting to measure thousands of a milliliter and to use a larger, easier to read 2mL or 5mL oral syringe to measure your dose.

If we were to increase the volume of the dilutant to 100mL and still use a 20mg tablet to make up the batch, we would get a Dilution Ratio of 1:5:

 

- 20mgai per 100mL of liquid is the same as 1mgai in 5mL of liquid.

 

To take 0.5mgai, for example, you would take 2.5mL of the liquid. To take 0.10mgai, you would take 0.50mL of the liquid, or half of a 1mL oral syringe.

 

IMPORTANT

 

To calculate the amount to take in mL, multiply the desired dose in mgai x amount of liquid.

As an example, with the above 1:5 Dilution Ratio, to take 0.21mgai, you would take 1.05mL of the liquid: 0.21mgai x 5mL = 1.05mL.  

In situations like this, where there is a tiny (0.05mL) involved, it can be hard to measure the dose accurately. To make it easier, it is best to round up to the next highest number. In this case 0.1 making the entire dose 1.1mL. For the Endgame Taper we want to always round up. This may result in a smaller decrease, but we are looking to minimize symptoms and add stability. It is always a good idea to keep notes about your method, dilution, and calculations – these things can become confusing.

Diluting Commercial Liquids

 

Before diluting a commercial liquid check the packaging for instructions. Many can be diluted with water, but some can’t, so it is best to check. If water is listed on the ingredients, then it is okay to add.

Diluting Compounded Liquids

(If you have a partial container of a compounded liquid, check with the pharmacist to find out what the dilutant is (it’s probably the pharmacy base Ora-Plus or Ora-Sweet). https://www.survivingantidepressants.org/topic/3068-pharmaceutical-liquids-to-make-suspensions/?tab=comments#comment-33735  A prescription from your doctor is required to have a pharmacy compound a new batch of liquid drug at a higher dilution ratio. You will have to confer with your doctor about what dilution ratio to use. If you can obtain the base liquid alone, then you could try diluting the compounded liquid yourself following the ratios described above.

 

 

BEAD COUNTING

 

True, this is not the best taper, but it can get a person down to one tiniest bead of Cymbalta or Effexor. At that point, it might be a good idea to hold on tapering for 2-3 months, then make the jump to “0” It would be a good idea to have a supply of the tiniest beads on hand to use for rescue doses. This is the only situation where it would be okay to take the drug intermittently as the rescue dose would be taken off and on as needed for a few weeks.

Generic brands of venlafaxine XR sometimes come in the form of 4 or 6 mini-tablets in a gelatin capsule. These mini-tablets are much larger than the beads and need to be tapered differently. The mini-tablets may be split, but the pieces becoming immediate-release venlafaxine, which needs to be taken 2 or 3 times a day. https://www.survivingantidepressants.org/topic/272-tips-for-tapering-off-effexor-and-effexor-xr-venlafaxine/?tab=comments#comment-2985  Switching to a brand of venlafaxine XR that contains beads enables continuing with the bead-counting method.

 

For only venlafaxine XR (Effexor XR) capsules containing tiny beads

 

While bead counting can be an effective method to taper Venlafaxine, some people will find making the jump from 1 bead is too high for this drug. If necessary, the tiny beads in Effexor XR may be made into a liquid with water. This applies only to Effexor XR, not Cymbalta, and only the type of venlafaxine XR capsules filled with beads about the diameter of a pin head, not the mini-tablets.

Surprisingly, these beads dissolve quite satisfactorily in water at a rate of 7.5mg/mL. The safety of this has been verified by Rosa, N. F. D., & Sharley, N. A. (2008). Stability of Venlafaxine Hydrochloride Liquid Formulations Suitable for Administration via Enteral Feeding Tubes. Journal of Pharmacy Practice and Research, 38(3), 212–215. https://doi.org/10.1002/j.2055-2335.2008.tb00841.x

The number of beads in capsules of venlafaxine XR vary by manufacturer and by dosage. Before embarking on this method, you will want to verify the average number of beads in your capsules of venlafaxine XR and the average MGAI of one bead. https://www.survivingantidepressants.org/topic/1461-counting-beads-in-a-capsule-versus-weighing/  

 

There is an easy method for making a liquid from one bead of Venlafaxine XR. Dissolving one (1) medium bead in 2mL of water will give a solution that is close to a 1:2 dilution ratio, an easy ratio to work with to make smaller reductions. Here is a technique that can be used to make one dose of liquid at a time. You need a 2mL syringe and one (1) medium bead of Venlafaxine XR.

 

- Remove the plunger from the syringe and drop in the bead.

- Replace the plunger and push it all the way in.

- Draw in water until the syringe is filled to the 2mL mark.

- Point the syringe nozzle straight up and draw a small amount of air into the syringe to allow the liquid to move when shaken. Let the syringe sit in this position in a cool dark place for a couple of hours. Gently shake the syringe several times during those few hours. This will allow time for the drug to dissolve out of the beads.

- When it’s time to take the dose give the syringe a gentle shake.

- Point the syringe nozzle straight up and carefully squeeze out any air. The liquid should be close to the 2mL mark. This will give a dose of the strength of one bead/2mL. As explained earlier the strength of one bead is variable and can range from 0.375 to 1mgai per bead.

For the next reduction, you can squirt out a bit more liquid, measuring your dose by aligning with other gradations on the syringe, for smaller and smaller doses. A standard 2mL syringe has marks for every 0.01mL.

If a large amount of the liquid is being discarded from your dose, you may wish to put it into a small bottle to use for the next dose. Be sure to shake it gently before removing a dose is from the bottle and store the bottle in the refrigerator between doses.

 

_____________________________

DRY CUTTING METHOD

Dry cutting or working with crushed/powdered tablets is not recommended for the Endgame Taper. It is inaccurate and changes from a hyperbolic taper to a linear taper with an ever-increasing reduction percentage. It is best to make the transition to a liquid at this time. For people who wish to continue to dry cut the following method can work quite well.

 

Starting with the smallest amount the scales can accurately weigh, 4mgpw, you will need to visually divide your pile of powder into eighths, or 12.5% portions. This will not be our 10% per month hyperbolic reduction, but it will have to do. First divide the 4mgpw powder into halves, then quarters, and then divide each quarter into 2 parts. You will have 8 piles.

Use a sharp object, like a razor blade or craft knife, to carefully divide the pile of powder into equal parts. As you’re working, you may wish to put each pile into a large gelatin capsule (size 00 works well) to preserve it.

Hold at each dose as required by listening to your body.

MONTH 1. For the first month’s reduction, you will take 7 of these piles each day, storing the 8th pile in a large gelatin capsule (size 00 or 000) to take later.

MONTH 2. The second month’s dose will be 6/8 of the 4MGPW powder, or 3/4. Divide your pile in half, and one of the halves in half again. That’s your ¾. Put the last ¼ into a gelatin capsule, label the container for use later.

MONTH 3. This dose will be 5/8 of the 4MGPW powder. Divide your pile in half, and one of the halves in half again, then divide each of the quarters into half, making 4 eighths. Take the half and one of the eighths as your daily dose. Save the other 3 eighths in gelatin capsules, keep them in a labeled container.

MONTH 4. This dose will be 4/8 or ½ of the 4MGPW powder. Divide your pile in half. One-half is your daily dose. Save the other half in a gelatin capsule in a labeled container to take the next day.

How do you feel? You have reduced to half the 4MGPW powder over 3 months. If you have withdrawal symptoms, stop here for a long hold, perhaps several months, before you taper slower.

To taper more slowly, divide the 4mgpw powder in half and each of the halves into 8 parts (each 1/16 or 6.25% of 4mgpw), following the same method as above. Taper using a similar stepwise method.

Using this method, you would no longer be making 10% reductions but would be making an initial 20% reduction. However, it is much easier to divide the original pile into 8 parts instead of 10. Making 10 piles would yield a 10% reduction for the first cycle. But as mentioned, this will be a series of linear reductions instead of hyperbolic reductions so the percentage will increase with each reduction.

It would be possible to make 10 piles, remove 1, recombine the remaining 9 piles and redivide them into 10, then use 9 of those piles to make up your dose. Using this progression each time would give something close to a 10% hyperbolic taper. But it would be very labor intensive and very prone to mistakes.

 

 

RESCUE DOSE

 

While tapering it is always better to error on the side of caution and go with smaller reductions or longer hold periods. If things have been stabilizing nicely and there is a sudden flair up of symptoms it may be possible to use a slightly higher “rescue dose” to break the cycle and help stabilize things. This however is not something that should be done on a regular basis, but rather as a “one shot” to get over a bad patch. If it is needs to be done more frequently, then an adjustment to the reduction amount may be called for.

A " rescue dose" is a tiny bit of the medication taken as a one-time thing to alleviate severe symptoms. Usually, it is done by dipping a toothpick liquid and sucking off the small drop of medication that clings to it. If dry cutting, moistening the end of a toothpick and dipping it in the powder and sucking it will work also. Instead of sucking on the toothpick it is also possible to place it under the tongue and hold it there for several minutes,

For people who are bead counting, taking one of the smallest beads available would be the method to use. It would be a good idea to have a supply of the tiniest beads on hand to use for rescue doses. This is the only situation where it would be okay to take the drug intermittently as the rescue dose would be taken off and on as needed for a few weeks.

Using a rescue dose is not a guarantee that things will improve, but it is worth a try if things get bad.

 

 

WDNormal

 

I see WDnormal as the overall baseline of where you are in general. The place you are when you're not feeling good, but you're not feeling bad. Sorta a rolling average of the past couple of months between the windows and waves.  Watching the level of WDnormal is a good indicator that things are improving.  Over time you should be seeing a raising of the standard for WDnormal.  So how you're feeling now is better than say six months ago. It changes very slowly but is a really good indicator.

 

 Many people have the idea that stability is feeling good again, when in fact it's feeling the same level of blah day after day with no big swings to the better or bad. When a person does a decrease in dose there will be a corresponding increase in WD symptoms over the next few days.  These symptoms will resolve themselves over the following several weeks and return the person to a slightly raised baseline of discomfort. The time frame and severity are dependent on a huge number of factors and end up being unique to each individual.  But the pattern remains.  This is why paying attention to your WDnormal is very important.  It is also referred to as listening to your body.  After a decrease in dose and the symptoms have resolved to WDnormal the person then should wait a couple of more weeks to let things really settle out (there are a lot of little unfelt changer still going on) before considering doing their next drop.

 

During that waiting time people may think that they're not doing anything and want to get on with it.  When in fact doing nothing is very proactive.  It's those little unfelt things that need to be finished up before the next step can be taken.  It's letting the glue harden, the paint dry, the cement cure.  The things that need to be complete before the path is safe to walk on again.  If these details are ignored then they start to pile up and compound each other, then somewhere down the line the foundation slips out from under us and the whole thing collapses.

 

As good as it gets for that moment.  WDnormal is a sliding scale of reference for tracking overall improvements in one’s condition. As you're learning this is a very slow process and at first changes in WDnormal are very small and slow in coming. As time passes and one’s body heals those changes become more pronounced and more frequent. But it can be frustratingly slow at first.

 

I'll bore you with a bit of my history, so you can see how I came up with the idea of WDnormal.  Many people find the time frames upsetting but I truly advocate going very slowly.   I'm one of the "lucky ones" in that I was only been on one drug, all be it for 23 years, which makes things a lot easier to sort out. I originally started on Paxil for Spontaneous Outbursts of Violent Anger and it really helped.  In reality I should have been through counseling instead of being drugged, but that's an irrelevant part of the story.  After many years on the drug it wasn't working as well so I updosed.  That helped sorta but a few years later I needed to updose again.  That helped for a few months, then I started downhill.  It took several years and becoming totally messed up to figure out I was in severe tolerance, or what we lovingly call "poopout".

 

Just making the decision to do something about it was a terrifying experience but after 18 years of being drugged, my marriage on the rocks and about to lose everything (probably even my life) I decided to do something about it.  Again, I was lucky and found a site called PaxilProgress before I made any changes. That started the entire process.  I liked the idea of the 10% taper but made a couple of modifications to make it gentler and started with that.

 

Nothing happened. I felt as bad as I had been.  Six weeks passed, and I did my second drop. Nothing happened, except maybe I felt a bit worse.  This pattern kept up for about 18 months.  When one day it hit me, "I hadn't felt as crappy for the past several weeks".  It took another six months before I again noticed that things had improved.  During this whole time all I could do was move doggedly forward making the best of it and learning to put up with and work around the symptoms.  I really had no other choice.

 

A little after two years I had my first widow.  It lasted about fifteen minutes, and it wasn't until several hours later I realized it had happened.  That was the point that it sunk in that the process really did work.  Except for that window the rest of the time was heavy brain fog, DR, no short-term memory, dizziness, all the symptoms we know and loath.  Another window opened briefly a few months later, and I noticed that I wasn't as "out of it" all the time and that I was gaining a little control over the symptoms by Acknowledging them, Accepting them and letting them Float off as I went about my life.

 

Finally, after three years of tapering I felt like I was making progress. I could see that I was improved from where I had started even though I knew I was by no means better.  I also could see that I was doing better that I was just six months before.  I realized that my "base line of feeling like crap was improving or how my WD symptoms normally felt was improving.  Hence WDnormal.

 

The last two and a half years, it will be a total of five and a half for the entire taper, brought fairly steady improvement.  I was able see improvements on a month over month and sometimes week over week basis.  To the point that many people would say I'm back to normal by the way I function. The last several months I know I wasn’t because I was still taking the drug. During my time on and tapering off of paxil I have learned a huge amount about myself, life and how to deal with things.  

 

So WDnormal is a pretty easy concept once you think about it. In a nutshell it’s ”as good as it gets at that time.”  It’s not feeling really good, it’s not feeling really bad, but rather a consistent level of feeling crappy that doesn’t change a lot from day to day for weeks at a time.  The length of time involved in seeing changes in your WDnormal is the most frustrating part. The improvements don’t happen from day to day, week to week or at times month to month.  In the beginning it can take six months to a year of more just to find what your WDnormal is and another six months to a year or more to see any significant improvements.  However, it is the best baseline for noting that improvement.

 

 

 

I Think I Have Anhedoina, But I Don’t Care

 

Anhedonia is one of those symptoms that really upsets people, and not with out cause.  It can be very unpleasant and disheartening. It is, however, a very important part of the healing/recovery process and needs to be embraced rather than feared.

 

I experienced anhedonia to some degree for a lot of my time on Paxil and during my taper off of it.  As I have mentioned before, I have done two major up doses while on Paxil. From 20mgai to 30mgai and again from 30mgai to 40mgai.  I first started to notice the anhedonia about a year into the change to 40mgai.  I had been going through a rough patch “life wise” for several years and thought that my lack of caring was due to the cumulative effects of life’s hard knocks.

 

During my downward spiral with the high dose of Paxil, drinking and continued life challenges, the anhediona continued to increase.  About the time I decided to do something about my life I pretty much didn’t care about anything.  I didn’t care enough to care about not caring. Until that flash of insight that set me on the path of righting my life.

It took getting sober and about two and a half years of tapering before I noticed any changes.  Another year and a half would pass before I really saw my emotions start to return.  From there it was a stead climb out of the black hole of emotionlessness. Once I made the jump to “0” things really started to improve. Today I still get small bouts that last for a few hours, but they are nothing like what it was in the beginning.  Now it’s more just normal emotional fluctuations like anyone would experience.

 

So, what did I do to get through it. Not a whole lot. I found that fighting against it only made things a whole lot worse. I found that accepting the anhedonia was much preferable to the alternatives of unrelenting anxiety and panic. I learned to look at anhedonia as a blessing in a way.  Without it I would have been feeling the over whelming panic and anxiety that is so common in WD.  Sure, I wasn't enjoying life, but I wasn't suffering either, and the loss of a happy life to it is only temporary. 

 

When it comes to WD, anhedonia is nature’s way of protecting us from the excruciating experience of constant panic attacks, nonstop anxiety, adrenaline rushes, cortisol spikes, palpitations, suicidal ideation, intrusive thoughts, and the like.  Your mind decides that it is better to feel nothing at all than to be put through the ringer 24/7 with emotions and sensations that wrack the body and soul and slow the healing/recover process to a snail’s pace.  When the mind is allowed to feel nothing, the body is then allowed to relax and direct its energy to where it really needs to be used. This provides for faster more complete healing, less painful WD symptoms and a better quality of life.

 

Yes, anhedonia is no fun.  Primarily because we make it that way.  We all want to regain our feelings as fast as possible.  But we are in a healing situation where the body needs to be allowed to do what it needs to do, because it knows best how to put itself back together.  Once we understand this, accept it, and stop fighting it we will start to heal at a faster rate and life will be much more pleasant as we do so.  

 

You can't fight against it.  This is a drug induced sensation that we have no control over.  Trying to fight it or overcome it just burns a lot of precious energy and causes a huge amount of frustration and anxiety because it doesn't help anything.  The emotions, feelings of joy, happiness, love, and excitement as well as creativity, ambition, and a whole lot more are being chemically suppressed and for the time being are just not accessible. Acceptance of the situation is the best path to follow.  As you reduce your dose further and your body has a chance to heal your emotions and all will slowly start to come back, but it does take a lot of time.

 

One thing I did learn was to look for and cherish all the little moments of joy.  They are popping up all the time but are very fleeting and easily overlooked.  When you look at a flower, instead of thinking "darn, I can't enjoy this flower", watch for the momentary little flash of joy that that flower brings when you first see it, and acknowledge it when it happens.  Stop and try to see the beauty in things, even if you don't feel it. "Wow, the sun on those clouds is really pretty, one day soon I will feel it again".  Stop and recognize the joy/wonder in the scene, but let your body react in its own manner.  This exercise will help reestablish the neural pathways and little by little dig out and strengthen the feelings. It is one of the symptoms that is really good to practice AAF on, as there is nothing you can do about it but live with it as best as you can.  Like a bad house guest, ignore it long enough and it will eventually go away.

 

Anhedonia can be a real relationship challenge.  I went through that for quite some time.  I learned that even though I couldn't call up or experience the feelings they were still there inside, just not accessible.  At the time I had been happily married for 33 years but couldn't summon up any of the feelings I had for my wife.  I mentioned this, and it lead to several "late night discussions".  Once we both understood that it was a manifestation of the drugs things started to improve.  After I had been tapering off of the Paxil for a while the feelings slowly started to show themselves, until, now I am more in love with her then ever.  We celebrated number 39 a couple of months ago.  It's a big test of a relationship, but if the feelings are true in the first place and both people trust each other it is something that can be gotten through and make the relationship all the stronger.

 

Like everything else we feel or don't feel in WD, Anhedonia comes and goes in waves and windows.  It is, however, frequently one of the last things to go.  Some people have it bad until after they jump off, while for others is clears up as they taper.  Given a lifetime, the time spent in ADWD/recovery is insignificant.  We have all had our "life" cruelly taken from us and want it back now.  But to get it back fully we need to let the WD/recovery run its course, put on a brave face, and accept whatever it throws at us, whether we can feel it or not.  With time, the healing will happen and when it knows we are ready, our minds will allow us to feel our full range of emotions again and life will be even better.

Edited by brassmonkey
Added WDnormal, Added Anhedonia

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.

Final Dose 0.016mg.     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

Link to comment
Share on other sites

  • 4 weeks later...

So to be overly clear. My solution is 20mg/mL so by adding 1,5 mg of water to my 1,5 mgai i am able to Draw 2,85 mgai the diluted solution?

2009 Escitalopram 10mg

April 2013 got off August 2013 reinstated 

July 2015 Ketipinor 50mg (Quetiapin)

April 2021 got off Quetiapin 4w taper

May 2021 tapered off Escitalopram 

9 August 2021 back on Escitalopram 2,5mg. Down to 2 mg. Updosed to 2,2mg August 24 Down to 2mg September 2

Updosed to 3mg Sept 28 

December Still holding ❤️

June 9 2022 2,9 mg

June 19 2022 2,85 mg

December 2022 switched syringes and realized i am actually taking 3,4 mg

Supplements vitamin E 400 magnesium malate a fraction of 400, Rosita Cod liver oil

Link to comment
Share on other sites

  • Moderator

No, if you cut the strength of the dose in half like this, then you have to take a dose that is twice as big to get the same amount of active ingredient. I gave specifics on your intro thread.

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.

Final Dose 0.016mg.     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

Link to comment
Share on other sites

I, too, am having trouble with bead counting and looking for some guidance. I am tapering Effexor 75 XR name brand. I count every bead in every capsule and divide 75 by the # of beads to get the aprox dose per bead. Example: 255 beads would be .294 per bead. I am trying to hold at 72.9. So in this case I would remove 7 beads (X.294) = 72.9 dose. But tomorrow's capsule is 275 beads (.272/bead) so I need 8 beads which is 72.8. This makes taking the same dose while holding difficult. I am very sensitive to meds and find I am having withdrawals some days because I go from 72.9 to 73. to 72.8 because of the variations in the number of beads.

 

Do you have any suggestions?  Thank you

Prozac 10mg 1990-1999    -1999-2018 Effexor XR 75 mg capsules

-2018 Dr direct switched me from Effexor 75XR to Cymbalta 20mg XR and 20 mg Metoprolol following irregular heartbeat incident  -Late 2019 began worsening anxiety/ depression symptoms     -2020 Dr direct switched  back to 75 mg Effex XR   Symptoms worsened   -2021 Changed Dr and began therapy for GAD and worsening physical symptoms   -2022 Found this forum and began slow taper by removing beads -    6/7 - 6/10 Effexor 73.2mg  6/11-6/14  Effexor 72.9mg   nightmares, tinnitus, anxiety;  6/15- Effexor XR 72.6mg  6/16 - 6/20 Effexor XR 72.8   nausea, heart palpitations, anxiety, tinnitus 6/22-7/4 hold Effexor XR 72.9-73.1     7/5-7/11  Effexor XR 72.62  7/12 - 7/15  Effexor 72.6  bad symptoms 

7/16-7/17 Effexor XR upped to 72.9  7/18 Effexor XR 72.9  most symptoms gone  hold at 72.9 - 73.0   8/26 - 9/6  Trying to keep dosage under 73. Holding around 72.9 sometime 72.86 due to bead count  Having symptoms most days.

9/6-9/23    Holding at about 72.9-73. Still very ill. No improvement.

9/23 - 11/23  Still keeping dose around 72.9-73

11-23-Jan 14   Held until one week ago. Dropped to 72.75-72.81  terrible WD

1/14- present   Worse WD symptoms. Back to 73.10. Cannot seem to stabilize. 

2/2 - present Holding at about 73 hoping to stabilize  

3/19 - present Dropped to aprox 92.9-92.88. (vary from day to day.) Holding 

Take only Clarinex 5mg for allergies and the Effexor 73 XR. I cannot take any supplements. No caffeine, sugar, soy, gluten, dairy.

 

Link to comment
Share on other sites

By the way, I have printed out and use your micro-taper spreadsheet. Thank you!

Prozac 10mg 1990-1999    -1999-2018 Effexor XR 75 mg capsules

-2018 Dr direct switched me from Effexor 75XR to Cymbalta 20mg XR and 20 mg Metoprolol following irregular heartbeat incident  -Late 2019 began worsening anxiety/ depression symptoms     -2020 Dr direct switched  back to 75 mg Effex XR   Symptoms worsened   -2021 Changed Dr and began therapy for GAD and worsening physical symptoms   -2022 Found this forum and began slow taper by removing beads -    6/7 - 6/10 Effexor 73.2mg  6/11-6/14  Effexor 72.9mg   nightmares, tinnitus, anxiety;  6/15- Effexor XR 72.6mg  6/16 - 6/20 Effexor XR 72.8   nausea, heart palpitations, anxiety, tinnitus 6/22-7/4 hold Effexor XR 72.9-73.1     7/5-7/11  Effexor XR 72.62  7/12 - 7/15  Effexor 72.6  bad symptoms 

7/16-7/17 Effexor XR upped to 72.9  7/18 Effexor XR 72.9  most symptoms gone  hold at 72.9 - 73.0   8/26 - 9/6  Trying to keep dosage under 73. Holding around 72.9 sometime 72.86 due to bead count  Having symptoms most days.

9/6-9/23    Holding at about 72.9-73. Still very ill. No improvement.

9/23 - 11/23  Still keeping dose around 72.9-73

11-23-Jan 14   Held until one week ago. Dropped to 72.75-72.81  terrible WD

1/14- present   Worse WD symptoms. Back to 73.10. Cannot seem to stabilize. 

2/2 - present Holding at about 73 hoping to stabilize  

3/19 - present Dropped to aprox 92.9-92.88. (vary from day to day.) Holding 

Take only Clarinex 5mg for allergies and the Effexor 73 XR. I cannot take any supplements. No caffeine, sugar, soy, gluten, dairy.

 

Link to comment
Share on other sites

×
×
  • Create New...

Important Information

Terms of Use Privacy Policy