bastringue: Is my tapering strategy good?

[bastringue]

Hi there,

 

Been using antidepressants for nearly 20 years. Started with Prozac, then citalopram, escitalopram, Zoloft, Cymbalta, amitriptyline, Remeron, tried Lyrica and some others as well.

 

Nice years ago I tried to stop cold turkey (I was taking 20 mg citralopram back then) and had the worst year of my life after that decision. Had conflicts with everyone, had terrible back pain, living was Hell.

 

Now I'm back a tapering, because at some point it was too much: I was drinking alcohol, drinking coffee, needed 20 mg melatonin to get asleep, took L-theanine, Remeron that knocked me off, 20 mg amitriptyline and 60 mg Cymbalta. I had ED from Remeron and the others, and felt really bad. Enough was enough. So I changed things.

 

In the last month, I eliminated everything except for the Cymbalta. I stopped alcohol, caffeine, amitriptyline, Remeron, L-theanine, and melatonin. And I started tapering off Cymbalta, going down 3 mg each week for 10 weeks, which is my objective, to be at 30 mg for winter and maybe try to taper off again next Spring.

 

So far it's difficult. Anxiety is going through the roof, sleep is only marginally better, feel anger all the time. I take magnesium, D3 and K2 to help me, but it only helps a bit.

 

Is my tapering strategy too fast? Any advice? Should I keep going or stabilize first, and any way to manage anxiety? Any supplement that could help? I think I was vitamin depleted from so many years of AD...

 

Thanks

[Frogie]

@bastringue

 

Welcome to SA. We are volunteer ran site helping people taper off psychiatric medications or have tapered off and are now healing.

 

This is your introduction page where you will receive information, ask questions and meet other members. We ask that you only have one introduction page so we can keep all your information in one place.

 

 

I'm glad to hear you are not drinking alcohol or caffeine, as these can cause a lot of problems with tapering and your CNS (central nervous system). Your tapering to fast and that is causing a lot of your symptoms also. We don't suggest more that 10% a month and many members go much slower than that.

 

Why taper by 10% of my dosage?

The slowness of slow tapers

 

 

Tips for tapering off duloxetine (Cymbalta)

 

 

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications:

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

 

 

I would hold on your current dose until you reach WD normal. Then do a very slow taper.

 

What is withdrawal syndrome?

 

The Windows and Waves Pattern of Stabilization

Dr. Joseph Glenmullen's withdrawal symptom checklist

 

 

Withdrawal Normal Description

 

 Waves and Windows in SSRI Withdrawal

 

 

 

We don't suggest supplements on here as they can be stimulating to the CNS (central nervous system). You could try 2 that we suggest. If you wish to try them, try one in a small amount and wait a few days before introducing the other.

 

Magnesium

Omega 3 Fish Oil

 

After reading the links provided please do not hesitate to reach out with any questions you may have.

[bastringue]

Thank you very much for the reply. 

 

I highly appreciate you consider how supplements could be stimulating the CNS. I know I am vitamin D3 deficient, but since I started supplementing in D3 and K2 (with magnesium) I feel really off, really stressed, like my adrenals are exhausted (worse than when I was taking caffeine), stressed by anything going on, and sleeping really really bad. I sleep worse right now than when I took all the meds with alcohol and caffeine. I wake up feeling extremely tired and my eyelids are twitching all the time, which is something that happen to me only when I am really tired.

 

My strategy when tapering off ADs was to replace some of it by vitamin D3, because I am deficient and because for the last 30 years or so each winter I feel depressed while I feel fine from May to October. Do you know of any strategy to replenish my D3 without stimulating my CNS? Lanolin-made D3 (the usual one) stimulates it much more than vegan (made from lichen). I see you are taking D3. What type and how many iu?

 

Yes, I decided to slow down my tapering. Maybe too fast. I will stay at 54 mg Cymbalta for the month, than decrease to 51 mg. next month, and go down slowly.

 

My biggest fear right now is that my mood is completely off, with anger, tiredness, and I wonder if it'll go away eventually. I can't really work while feeling that way, and I need to find a way to find a balance. I really thought vitamin D3 would help me, but so far it only created anxiety.

[Frogie]

@bastringue

 

You may want to try taking the Vitamin D in the morning, it is called the sunshine vitamin for a reason. Or you could try sitting in the sun to get natural Vitamin D and see how you do. It can be stimulating in large quantities though.

 

You could try to go down to 51 mg as that is only a 5% decrease and you may have better luck going slowly that way. But I would give it a couple months before tapering so you can stabilize.

 

Please keep us updated and let me know if you have any other questions I can answer.

 

 

 

 

[bastringue]

Thank you very much. I will definitely taper down to 51 mg to stabilize... and wait a bit to do it. It's really difficult right now. Is it normal for a 10% drop to be so difficult or can it be because I stopped Elavil last month and stopped alcohol and caffeine as well?

 

As for the sun, the main problem is winter. Here where I live it's like -20 to - 30C for months and the sun sets down at 4 PM, so getting sunshine in winter is a big problem. 

 

I tried taking D3 in the morning, but still got this anxiety from it. Same thing from magnesium, but maybe I am already taking too much magnesium from food? (I love natural peanut butter and I've read it's 57 mg magnesium per 2 tbsp and I take like 10 tbsp every day, so maybe I feel bad on magnesium because I have too much and it depletes potassium or sodium?)

 

Thank you very much!

[bastringue]

Tapering off Cymbalta (after stopped taking Elavil)

 

I am slowly tapering off Cymbalta. So far, it's been week 3 on 54 mg, going down from 60 mg. Last month, I stopped Elavil (amitriptyline): I was taking 20 mg and went down to 0 in three-four weeks. I know this is really fast... Right now I have massive anxiety and I was wondering if it's normal that the anxiety only kicked like two weeks after I stopped Elavil. I thought it would have started as soon as I got Elavil-free, but I was fine for over a week, and then it started. 

 

Also, anyone has any idea how much time will this anxiety last? When will I get back to 'normal', whatever that is?

 

Edited September 16, 2022 by ChessieCat
added Intro topic title before merging with intro topic

[bastringue]

Was feeling not too bad, so it's being 4 days on 51 mg. My eyelid is twitching, my hands are shaking, I want to yell at everyone and I don't sleep much at all, with anxiety through the roof. Is this normal? Will it be that way every time I decrease a little bit the dosage?

[ChessieCat]

On 9/16/2022 at 10:47 PM, bastringue said:

Last month, I stopped Elavil (amitriptyline): I was taking 20 mg and went down to 0 in three-four weeks.

 

Please add the information of the 3-4 weeks 20mg to 0mg and include the date when you stopped the drug.

 

Account Settings – Create or Edit a signature

 

On 9/16/2022 at 10:47 PM, bastringue said:

I am slowly tapering off Cymbalta. So far, it's been week 3 on 54 mg, going down from 60 mg.

 

I think that you have started tapering Cymbalta too soon after doing the fast taper of the Elavil / amitriptyline.  If the symptoms are unbearable then you might consider making a small updose, perhaps to 57mg or 58mg.

[bastringue]

How much time do you think I should have waited before tapering Cymbalta? I thought Elavil 20 mg was such a small dose it didn't make a difference... 

 

Do you think if I stay at 51 mg everything will eventually get back to normal or I should absolutely take a higher dose? 

[bastringue]

Moved from:  The Brassmonkey slide topic

 

Seems interesting, I might try it. It's really long however. 

 

Do people really have more trouble with the 10% monthly tapering plan?

 

Edited September 27, 2022 by ChessieCat
added moved from info

[brassmonkey]

We are having great success with people using this method. With the straight 10% a month there tends to be a very heavy hit of symptoms right after the reduction which can be rather debilitating. This method makes the hit a lot smaller and spreads it out over several reductions. Many members are reporting greatly reduced symptoms.

 

Yes, it does take a long time, but any properly done taper does. The 10% a month recommendation is just a starting point and is the fastest taper we recommend. However, most people find it too harsh and have to go slower.

[bastringue]

Will I be able to get better as tapering goes on? One of my worst antidepressant side effect is erectile dysfunction. Any chance it get better before going to zero? I don't care to taper for five years if I see I get better regularly, but if I have to wait five years to see results... 

 

From what you observed or you experienced, does the ADs side effects get better as the tapering goes on or one has to get to a pretty low dosage to see positive results?

 

Thanks

[ChessieCat]

4 hours ago, bastringue said:

Seems interesting, I might try it. It's really long however. 

 

Do people really have more trouble with the 10% monthly tapering plan?

 

You might find that for the first part of a taper, depending on your own drug history, that you may be able to reduce by 10% every four weeks or so.  However, many members find that the lower their dose gets the slower they need to go, reducing less and/or holding for longer.  This is where the Brassmonkey taper might be a better option.

 

See the following which helps to explain why this might be the case:

 

Why taper paper: dose-occupancy curves

[ChessieCat]

About half way through my taper my emotions started returning and I began enjoying things.

 

7 minutes ago, bastringue said:

I don't care to taper for five years if I see I get better regularly, but if I have to wait five years to see results... 

 

The idea of SA's tapering protocol is to keep withdrawal symptoms to a minimum whilst being able to live your life as normally as possible during the process.

 

Please read:

 

Cold Turkey and Too-Fast Tapers

 

You might also find it helpful to read the

 

Success stories: Recovery from psychiatric drug withdrawal

[ChessieCat]

9 hours ago, bastringue said:

How much time do you think I should have waited before tapering Cymbalta? I thought Elavil 20 mg was such a small dose it didn't make a difference... 

 

Do you think if I stay at 51 mg everything will eventually get back to normal or I should absolutely take a higher dose? 

 

It's up to you whether you stay at this dose or updose a small amount.  If you are going to updose it needs to be done fairly quickly.  It takes about 4 days for a dose change to get to a steady level in the blood and a bit longer for it to register in the brain.  When making changes in dose, it is generally better to make small increases/decreases because it is gentler on your system.

 

The idea of tapering by small amounts is to allow the brain to only need to make small changes at a time instead of having to make a lot of changes at the same time.  See:

  

On 8/31/2011 at 5:28 AM, Rhiannon said:

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.

 

Edited September 27, 2022 by ChessieCat
typo

[bastringue]

Thanks, I will check those links.

 

Do you think my antidepressants side effects would gradually go away as I taper or I need to wait until it is over and I am at zero? I know I must not go too fast, but I'd like to see some changes about those side effects. Since I used a bit Remeron in 2022 I have nearly total ED, so I thought stopping everything could reverse the damage. But I would like to know if it would get better BEFORE getting to zero, so I can try to taper very slowly...

 

It was really difficult to taper 10% off Cymbalta right from the start, but it may also be because I quit amitriptyline really fast last month. I can't make my mind right now and feel so bad anyway, so can't think straight. If I'd know that it would get gradually better as I take a lower dose and that I would regain some energy, I think it would help...

[ChessieCat]

Generally side effects are dose related, so the higher the dose the worse the side effects.

[ChessieCat]

18 minutes ago, bastringue said:

It was really difficult to taper 10% off Cymbalta right from the start, but it may also be because I quit amitriptyline really fast last month.

 

I am fairly certain that you are experiencing withdrawal symptoms from stopping the amitriptyline so quickly.  And you have made things worse by reducing the Cymbalta before you were stable from stopping the amitriptyline.

[bastringue]

Thanks, so basically at some point even if I slowly taper I can get better anyway. That's good, and I might try this tapering strategy.

 

Is it too late for me and I should go back to a higher Cymbalta dose or if I stick around it should be OK in a couple of weeks, providing I don't taper down until that time?

 

I've read some people talking about how dangerous it can be not to allow time for the brain to adapt. I don't want to take risks... but at the same time I feel like I'm taking poison and want to stop ASAP...

 

BTW, can there be permanent damage from too-fast tapering or cold-turkey?

[ChessieCat]

What does of Cymbalta are you currently taking?

 

Your signature says you are taking 51mg but recently you said you were taking 54mg.

 

My response to you going from 60mg to 54mg was:

 

20 hours ago, ChessieCat said:

I think that you have started tapering Cymbalta too soon after doing the fast taper of the Elavil / amitriptyline.  If the symptoms are unbearable then you might consider making a small updose, perhaps to 57mg or 58mg.

 

[bastringue]

I take 51 mg. I don't want to go up, ever again, unless I risk having permanent damage from staying at this dose. I was feeling a bit better at 54 mg so I tried 51 mg and here I am. Are there any risks beside feeling like crap for a week or two, from not going up and staying at 51 mg?

 

BTW I checked one of the link you shared. There is that study that basically says that Cymbalta doesn't change much between 20 mg and 60 mg, so would it be a good strategy to taper faster until 20 mg and slower after that?

[Faure]

9 hours ago, bastringue said:

Do you think my antidepressants side effects would gradually go away as I taper or I need to wait until it is over and I am at zero

My side effects have reduced greatly since I started my taper about 15 months ago. I still have problems with fatigue which was my mail problem all along, but i can do much more than I could when I started the taper. 

[bastringue]

2 hours ago, Faure said:

My side effects have reduced greatly since I started my taper about 15 months ago. I still have problems with fatigue which was my mail problem all along, but i can do much more than I could when I started the taper. 

 

That's positive news! But maybe it's different because of the type of drug? I took mirtazepine at 5 mg for a while last winter and spring and man was I tired all the time. Was also the worst for PSSD... 

 

I am so tired all the time right now, I hope if I take less Cymbalta I will have more energy.

[ChessieCat]

Generally antidepressants are activating.

 

Mirtazapine is sedating at lower doses than it is at higher doses.

 

I will ask the other staff which order of reducing might be better.

 

From:  https://www.psychdb.com/meds/antidepressants/nassa/mirtazapine

Why Do Lower Doses of Mirtazapine Cause More Sedation?

Quote

Mirtazapine acts mainly on 3 receptors: histaminergic, noradrenergic, and serotonergic receptors. However, at low doses (e.g. - 7.5 mg), mirtazapine has a higher affinity to (and thus preferentially blocks) the histamine-1 receptor, compared to the other 2 receptors.^[2][3] At higher doses, this antihistamine activity is offset by increased noradrenergic transmission, which reduces its sedating effects.^[4][5] Although sedation is expected at low doses, it is usually most noticeable in the first few weeks of therapy and diminishes with continued treatment.^[6]

[ChessieCat]

10 minutes ago, bastringue said:

I am so tired all the time right now

 

Q:  When did this tiredness start?  Did you have it before you stopped the Elavil/amitriptyline?  Or did it start afterwards?

[bastringue]

1 hour ago, ChessieCat said:

 

Q:  When did this tiredness start?  Did you have it before you stopped the Elavil/amitriptyline?  Or did it start afterwards?

 

No, been tired for years. Even when I sleep 'well', I wake up tired. Took blood test, everything normal. Don't have sleep apnea. Still sleep like crap. It's like I don't get to deep sleep. I wonder if this may be SSRI/SNRI related? I don't remember having this problem before I started them, but I was much younger then... 

[Altostrata]

@bastringue you have been on antidepressants almost continuously for 17 years, with lots of drug switches. It's possible your fatigue has always been related to antidepressants.

 

How long have you been taking 51mg duloxetine? How has your symptom pattern changed since you reduced to 51mg? 

[bastringue]

41 minutes ago, Altostrata said:

@bastringue you have been on antidepressants almost continuously for 17 years, with lots of drug switches. It's possible your fatigue has always been related to antidepressants.

 

 

It's possible, but I suspect at some point that citalopram pooped out, and I was still fatigued back then. Extreme fatigue for at least 10 years, maybe more. I know that caffeine make it worse, but even when I'm off caffeine for a week or more I'm still so tired. The switch was because my doc tried to find something that worked, because clearly citalopram was not working. Escitalopram was like citalopram (duh!) and sertraline made me even more tired. So that's how I ended on duloxetine. Fatigue still the same. Never had a sleep study, but confident it's not sleep apnea because women who slept at my side never said I snored.

 

Would it be possible that antidepressants prevented me from reaching deep sleep?

 

 

41 minutes ago, Altostrata said:

How long have you been taking 51mg duloxetine? How has your symptom pattern changed since you reduced to 51mg? 

 

I've been at 51 mg for one week today. 

 

I was at 60 mg on August 29, then August 30 at 57 mg, September 4 at 54 mg, and September 22 at 51 mg. I think it was too fast, considering I also stopped amitriptyline from 20 to 0 in August, stopped mirtazapine CT (but I was taking it maybe 2-3 times a week), stopped alcohol as well and trying to stop caffeine. My symptoms were OK at first, but were worse after a couple of days. Saturday I had caffeine and Sunday to Tuesday were really bad days. Today I feel a bit better, but like 3/10 instead of 2/10 I'd say. Anxiety is bad, I feel really tired when waking up in the morning, and I shake a bit, especially my eyelid is twiching.

 

[Altostrata]

You reduced 9mg from August 29 to September 22. We recommend a reduction of 10% per month.

 

Up to you whether you want to updose slightly, perhaps to 53mg, or ride out your withdrawal symptoms. If I were you, I would not reduce any further until after your withdrawal symptoms go away. Suggest you stop caffeine as well, since it seems to exacerbate your problems.

 

Yes, antidepressants are known to affect sleep.

[bastringue]

OK I will not reduce for sure for a while. Will think about raising it back to 53 mg. If I stay at 51 mg do I risk permanent damage or I simply have to wait until symptoms are gone and then move on?  Would I eventually stabilize (and feel better) at 51 mg if I wait long enough or do I risk permanent damage?

 

Do you think there is any chance that maybe my symptoms are not related to me going from 60 to 51 mg Cymbalta, but maybe because I stopped Elavil in August?

 

Yes I know they affect sleep, but was wondering if others do suffer specifically from poor deep sleep, and even after all those years. When my med pooped out I thought sleep should get better, but it did not.

 

Thanks!

[Altostrata]

8 hours ago, bastringue said:

Do you think there is any chance that maybe my symptoms are not related to me going from 60 to 51 mg Cymbalta, but maybe because I stopped Elavil in August?

 

What new symptoms appeared after you stopped Elavil in August? When was your first duloxetine reduction?

 

It's possible antidepressants have always adversely affected your sleep, or it could be drug switches, drinking, caffeine, other drug use, etc.

[bastringue]

1 hour ago, Altostrata said:

 

What new symptoms appeared after you stopped Elavil in August? When was your first duloxetine reduction?

 

It's possible antidepressants have always adversely affected your sleep, or it could be drug switches, drinking, caffeine, other drug use, etc.

 

Everything went smoothly when I stopped Elavil, at first. I tapered down like 3 mg each week from last week of July to third week of August, and for the first 2-3 days after each tapering I was a bit dizzy, but it went smoothly enough. Last dose of Elavil was 2 mg on August 23. From checking my note, I wasn't taking 20 mg every night when I began to taper down, more likely 10 mg some night and 20 mg other nights (mainly when I was drinking alcohol... which I stopped as well... Elavil made me sleep through the night without waking up at 3 AM with the heart racing... In the end, I used Remeron for the same reason).

 

I began tapering down Cymbalta on August 30, from 60 mg to 57 mg and on August 31 I began to experience more anxiety. Then a couple of days later I tapered down from 57 to 54 then I began to feel much worse, with slight tremors, twitching eyelid (which may be caused by fatigue) and insomnia. Still experiencing insomnia right now; woke up at 4 AM this morning and couldn't sleep again, and even when I sleep I don't sleep really well.

 

From 2005 to 2022 I only used ADs, alcohol or caffeine. in 2016 I stopped alcohol and caffeine for a year, but got a depression. Got like 4 depressions or massive stress events in the last 6 years. Problem is I am always tired like hell and so my mood isn't good and even really slight stress can build up really fast. I am in my forties but feel like in my eighties: can't drive my car too fast (everything goes too fast around me and it stresses me), got PSSD, have trouble sleeping. Sometimes I wonder if after 17 years on ADs maybe my central nervous system has some damage. When I was young, I also took drugs for a couple of years, so maybe that played a part.

 

But my main problem is still sleep. Was for years, and still is, right now, like right now I am typing but so sleepy my eyelids are like half closed. But still, can't sleep in the day. And when sleeping, doesn't wake up feeling too good. Before I began to taper down the ADs, I got maybe 3-4 good nights of sleep per year, e.g. when I wake up and feel refreshed, etc.

 

Did you experience trouble with sleep while you were on ADs? Do you know about people who had trouble reaching deep sleep and where it got better after quitting ADs?

[Altostrata]

You went off amitriptyline in an irregular way, with inconsistent dosing. 

 

What we have seen is that alcohol use makes withdrawal much worse and can renew withdrawal syndrome. It's possible that intermittent drinking may have impeded your nervous system adjusting to your drug reductions. 

 

The way you describe your hypersensitivity and slight disorientation sounds a lot like withdrawal syndrome.

 

[bastringue]

5 hours ago, Altostrata said:

You went off amitriptyline in an irregular way, with inconsistent dosing. 

 

What we have seen is that alcohol use makes withdrawal much worse and can renew withdrawal syndrome. It's possible that intermittent drinking may have impeded your nervous system adjusting to your drug reductions. 

 

The way you describe your hypersensitivity and slight disorientation sounds a lot like withdrawal syndrome.

 

 

Yeah, that was stupid. Do you think I should try to reintroduce amitriptyline, and maybe taper more slowly, or is it too late? I had trouble tapering down anyway as I am so sensitive that I can't divide the pill in any easy way. With duloxetine it is much easier, as I simply count the beads!

 

I am 100% sober on alcohol, didn't drink anything for nearly two months.

 

Right now I don't feel well at all. Got severe stomach pain last night, looking like a ulcer. I had such pain maybe 5-6 times a year before I started ADs and in the first months when I started citalopram. Feels like my stomach is in fire, last for maybe 10-12 hours, 8/10 pain. My anxiety is off the charts, so maybe this is what caused the problem.

 

Do you think I should go back on amitriptyline, maybe temporarily? And what is the best way to taper with those pills? If I decide to put them into water, let's say 50 mg for 50 ml and use a syringe, would it be a good strategy to restart at 5 mg and then use the brassmonkey strategy, going down 2.5% per week with two weeks on hold every month. And if I do that, would I be able to taper duloxetine at the same time, using the same strategy?

 

 

[bastringue]

And if I go back on amitriptyline, do you think 5 mg would be enough to stabilize, and maybe take it from there and sloooooowly taper down amitriptyline and duloxetine at the same time? I used to take between 10 mg and 20 mg daily, but mostly 10 mg on days when I did not drink alcohol. I think the long half-life may explain why I did not experience problems doing that but it's really hard now that I'm at zero.

 

Thanks a lot!

[ChessieCat]

I will ask the other staff for their thoughts on this.