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Tips for tapering off lithium


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Altostrata

Correct, ar. If all of this was clear and well-understood by doctors, this site would not exist.

 

Drug manufacturers do not want you to split your tablets because they want you to be consistent in your dosing.

 

If you wish to stay on lithium for the rest of your life, you are free to do so.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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All extended release formulations have this warning.  Different drugs have different protocols for dealing with the ER/XR/SR formulations.  

 

Effexor, we count beads and don't break up the XR formula.

 

Lithium, which is a more primitive drug, is as simple as cut and divide the does into 2 immediate release doses per day.

"Easy, easy - just go easy and you'll finish." - Hawaiian Kapuna

 

Holding is hard work, holding is a blessing. Give your brain time to heal before you try again.

 

My suggestions are not medical advice, you are in charge of your own medical choices.

 

A lifetime of being prescribed antidepressants that caused problems (30 years in total). At age 35 flipped to "bipolar," but was not diagnosed for 5 years. Started my journey in Midwest United States. Crossed the Pacific for love and hope; currently living in Australia.   CT Seroquel 25 mg some time in 2013.   Tapered Reboxetine 4 mg Oct 2013 to Sept 2014 = GONE (3 years on Reboxetine).     Tapered Lithium 900 to 475 MG (alternating with the SNRI) Jan 2014 - Nov 2014, tapered Lithium 475 mg Jan 2015 -  Feb 2016 = GONE (10 years  on Lithium).  Many mistakes in dry cutting dosages were made.


The tedious thread (my intro):  JanCarol ☼ Reboxetine first, then Lithium

The happy thread (my success story):  JanCarol - Undiagnosed  Off all bipolar drugs

My own blog:  https://shamanexplorations.com/shamans-blog/

 

 

I have been psych drug FREE since 1 Feb 2016!

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  • 1 year later...

@JanCarol 

 

I currently take 900mg extended release lithium at night (I’ve stabilized from Paxil and zoloft withdrawal of 8 months ago). I already received liquid so that I can go down 10mg the first week - super slow.
 

My only question is with switching from extended release to immediate release.  Do I continue taking it at night (all 890 mg)?  Do I break it up morning and night?  
 

Can’t seem to find an answer and doctor doesn’t know as it’s never come up.  
 

Thanks!

- for 16 years took: morning: lexapro 10 mg, wellbutrin xl 150mg; evening: paxil 2.5 mg, zoloft 25mg

- feb 22:  tried to change and decreased paxil to 1.25 and zoloft to 50 and experienced eurphoria and possible mania, needed less sleep, etc.

- decreased zoloft back to 25 over 2 weeks and decreased paxil to 0

- withdrawal started a few days later and increased paxil back to 1.25 - stabilized but flat after a couple days (eventually got paxil back to 2.5)

- also took levaquin for possible prostatitis

- never really improved and we tried deplin, different formulations of generics and brand names

- Mid June 2019 lost the ability to sleep completely

- 7/1/19 cold turkeyed in hospital off 2.5 paxil and shortly thereafter 25 zoloft, titrated lithium up to 1200 but settled at 900mg

- 8/10/19 tried 12.5 lexapro for 2 weeks with disastrous sensitivities 

- 8/26/19 and currently: morning: 10 mg lexapro, 150 wellbutrin xl; evening: lithium 900 mg (Took klonopin for wknd)
9/20 tapered to 780mg lithium from 900mg - hypomania almost immediately, tinnitus, dizziness, pain, burning, freezing cold

- 9/29 reinstated to 900mg lithium

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  • 4 weeks later...
ResilienceandHope

@Frankgrimes

 

Did you ever find the answer to the question about switching from extended release to immediate release?

 

Edited by ChessieCat
added @

2003-2018: Various amounts of Paxil from 20 mg to 5 mg. Occasional Xanax .25 mg for sleep (8-10 times annually)

April 2018: .5 mg Xanax 3 times daily, 10 mg Paxil due to insomnia after horrible experience building a new house with delays.
June 2018: Increase to 20 mg Paxil and continued Xanax.  Horrible side effects and interdose w/d from Xanax(didn't know at the time).
September 2018: .5 Klonopin daily, 30 mg Mirtz, 60 mg Prozac. 
October 2018:  Developed UTI. Floxed with Cipro. Sent me into acute w/d.
November 2018: Switched to 5 mg Valium to try and control interdose w/d. January 2019: Switched to liquid Valium to start taper following Ashton Manual.

Mid February 2019: Ashton schedule too fast, switched to daily liquid micro taper for duration

Mid April 2019: Finished taper Mid May 2019: Started taper Prozac and Mirtz. 10% every 2 weeks.  Too fast. Holding until I feel better. Currently at 40 mg Prozac and 27 mg Mirtz. May 2019: Continue taper. Complete Prozac taper November 2019  January 2020: Complete Remeron taper

March 31, 2020: SOMETHING IS VERY WRONG! Woke up in a panic and everything went downhill fast. Insomnia, audio hallucinations, extreme anxiety and akathesia. Attempted suicide and was put in hospital. Put on cocktail of drugs. 80 mg Prozac, 15 mg Remeron, trazedone 75mg, Lithium 300mg. Took meds because I was terrified. June 3, 2020: Still having terrible withdrawal symptoms.

 

 

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  • 4 months later...

Hi!

 

I am trying to understand how to safely reinstate & the taper slow release Lithium sulfate, which seems to exists only in Italy.

Can anyone please help me / give me some advice?

Here is my introduction topic and in the last posts you will read what I am doing at the moment, not very successfully.

Please note that in my country neither componding pharmacies nor liquid lithium exist.

@Altostrata@Meimeiquest @KarenB @JanCarol

 

2008:  diagnosed with major depressive disorder and generalized anxiety disorder .  Since then:

  • Treated with different SSRI (Paroxetine, Fluoxetine, Escitalopram, a mix of Escitalopram and Venlafaxine, Venlafaxine, Sertraline) and benzodiazepines 
  • One serious anxious/depressive episode, unrelated to changes in medications, culminating in a brief hospitalization
  • Two attempted withdrawal/reduction of drugs, trying to plan pregnancy, under psychiatric supervision. They both ended with a "relapse" diagnosis and the last one  (2019) ended also with a strong increase in medications (Lithium sulfate 124,5mg, Olanzapine 5mg, Sertraline 100mg)

2020: third attempt at withdrawing (planning pregnancy),  still on-going.  

  • February/March: following Psychiatrist recommendation, added 25mg of Setraline, reaching 125mg, then cold turkeyed Olanzapine. After 2/3 days: tinnitus,  'exploding' chest and head, derealization, irritability, mild anxiety. After 4 weeks: lack of concentration, tiredness, fatigue, sadness. Held there for a while and in June/July started to feel better.
  • October 25th: following Psychiatrist recommendation, Lithium  from 124,5mg to 83 mg in 1 day. After 4 days: first physical symptoms (fatigue, headache, nausea, 'exploding' chest and head).  After 2 weeks:  also psychological symptoms (mild anxiety, growing irritability, light head, difficulty to focus and to sleep)  
  • November: Discovered survivingantidepressants.org and on November 30th reinstated 2mg of Lithium , on top of 83mg dose. Immediate relief.
  • December 29th: eliminated the 2 resinstated mg. After 6 days:  general  sense of agitation, irritability, mild anxiety, insomnia, 'exploding head', mitigating after 10/15 days. Next step: mid February, from 83mg to 75mg.

 

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  • Moderator Emeritus
On 12/6/2020 at 10:36 AM, GNz11 said:

Please note that in my country neither componding pharmacies nor liquid lithium exist.

 

I did a search and found this one:

 

https://www.myerleepharmacy.com/naples/

Edited by Shep
updated with new username in quote box

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

Plodding along inch by inch:  12" = 1',  3' =  36 " or 1 yard,  1760 yards  = 63,360" or 1 mile

Current from 17 Apr 2021:  Pristiq 0.2665mg  now holding each dose for 3 weeks

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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@ChessieCat thank you very much, but unfortunately that one is in Naples, USA (not Naples, Italy)

2008:  diagnosed with major depressive disorder and generalized anxiety disorder .  Since then:

  • Treated with different SSRI (Paroxetine, Fluoxetine, Escitalopram, a mix of Escitalopram and Venlafaxine, Venlafaxine, Sertraline) and benzodiazepines 
  • One serious anxious/depressive episode, unrelated to changes in medications, culminating in a brief hospitalization
  • Two attempted withdrawal/reduction of drugs, trying to plan pregnancy, under psychiatric supervision. They both ended with a "relapse" diagnosis and the last one  (2019) ended also with a strong increase in medications (Lithium sulfate 124,5mg, Olanzapine 5mg, Sertraline 100mg)

2020: third attempt at withdrawing (planning pregnancy),  still on-going.  

  • February/March: following Psychiatrist recommendation, added 25mg of Setraline, reaching 125mg, then cold turkeyed Olanzapine. After 2/3 days: tinnitus,  'exploding' chest and head, derealization, irritability, mild anxiety. After 4 weeks: lack of concentration, tiredness, fatigue, sadness. Held there for a while and in June/July started to feel better.
  • October 25th: following Psychiatrist recommendation, Lithium  from 124,5mg to 83 mg in 1 day. After 4 days: first physical symptoms (fatigue, headache, nausea, 'exploding' chest and head).  After 2 weeks:  also psychological symptoms (mild anxiety, growing irritability, light head, difficulty to focus and to sleep)  
  • November: Discovered survivingantidepressants.org and on November 30th reinstated 2mg of Lithium , on top of 83mg dose. Immediate relief.
  • December 29th: eliminated the 2 resinstated mg. After 6 days:  general  sense of agitation, irritability, mild anxiety, insomnia, 'exploding head', mitigating after 10/15 days. Next step: mid February, from 83mg to 75mg.

 

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  • Moderator

There is no need to compound lithium, it is actually one of the easiest ones to taper.

You can either measure dry weight, like I did (easy to make mistakes, but workable), or dissolve in liquid.

Because of XR, you may need to dose twice daily when you break a tablet.  Usually twice daily is sufficient.  

 

I don't know how it is in Italy (for example, here in Australia, Lithium Orotate is not readily available) but in the USA, lithium orotate is readily available, and can be taken in small amounts to help with your taper, instead of the sulfate.  I am only familiar with lithium carbonate and lithium orotate - so I am unsure of the bioavailabililty and uptake of lithium sulfate.

For example, lithium carbonate, the powder is 18.8% lithium, while lithium orotate is only 3.83% lithium, but the uptake is - more bioavailable  (studies done with rats found it was easier to OD on orotate than carbonate, even though the percentages of active lithium were lower).  I do not have this figure for lithium sulfate.

If you are taking more than 5 mg lithium orotate, blood tests are required to make sure you are not damaging kidneys or liver.  I would suggest every 6 months, but if you are taking more, it may need to be every 3 months.

"Easy, easy - just go easy and you'll finish." - Hawaiian Kapuna

 

Holding is hard work, holding is a blessing. Give your brain time to heal before you try again.

 

My suggestions are not medical advice, you are in charge of your own medical choices.

 

A lifetime of being prescribed antidepressants that caused problems (30 years in total). At age 35 flipped to "bipolar," but was not diagnosed for 5 years. Started my journey in Midwest United States. Crossed the Pacific for love and hope; currently living in Australia.   CT Seroquel 25 mg some time in 2013.   Tapered Reboxetine 4 mg Oct 2013 to Sept 2014 = GONE (3 years on Reboxetine).     Tapered Lithium 900 to 475 MG (alternating with the SNRI) Jan 2014 - Nov 2014, tapered Lithium 475 mg Jan 2015 -  Feb 2016 = GONE (10 years  on Lithium).  Many mistakes in dry cutting dosages were made.


The tedious thread (my intro):  JanCarol ☼ Reboxetine first, then Lithium

The happy thread (my success story):  JanCarol - Undiagnosed  Off all bipolar drugs

My own blog:  https://shamanexplorations.com/shamans-blog/

 

 

I have been psych drug FREE since 1 Feb 2016!

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@JanCarol,

I really appreciate your reply!

 

I developed withdrawal symptoms moving from 124,5mg of slow release lithium sulfate to 83mg (in "one shot", as my psychiatrist told me to do).

Since then I reinstated 5% of the total cut (so 2mg) but I noticed this: on the third day using the same crushed tablet I experience withdrawal.

Could it be that the crushed pill "degrades" in time?

 

At the moment I've decided to throw everything away after the secondo day and I feel better. I really hope it will continue like this!

2008:  diagnosed with major depressive disorder and generalized anxiety disorder .  Since then:

  • Treated with different SSRI (Paroxetine, Fluoxetine, Escitalopram, a mix of Escitalopram and Venlafaxine, Venlafaxine, Sertraline) and benzodiazepines 
  • One serious anxious/depressive episode, unrelated to changes in medications, culminating in a brief hospitalization
  • Two attempted withdrawal/reduction of drugs, trying to plan pregnancy, under psychiatric supervision. They both ended with a "relapse" diagnosis and the last one  (2019) ended also with a strong increase in medications (Lithium sulfate 124,5mg, Olanzapine 5mg, Sertraline 100mg)

2020: third attempt at withdrawing (planning pregnancy),  still on-going.  

  • February/March: following Psychiatrist recommendation, added 25mg of Setraline, reaching 125mg, then cold turkeyed Olanzapine. After 2/3 days: tinnitus,  'exploding' chest and head, derealization, irritability, mild anxiety. After 4 weeks: lack of concentration, tiredness, fatigue, sadness. Held there for a while and in June/July started to feel better.
  • October 25th: following Psychiatrist recommendation, Lithium  from 124,5mg to 83 mg in 1 day. After 4 days: first physical symptoms (fatigue, headache, nausea, 'exploding' chest and head).  After 2 weeks:  also psychological symptoms (mild anxiety, growing irritability, light head, difficulty to focus and to sleep)  
  • November: Discovered survivingantidepressants.org and on November 30th reinstated 2mg of Lithium , on top of 83mg dose. Immediate relief.
  • December 29th: eliminated the 2 resinstated mg. After 6 days:  general  sense of agitation, irritability, mild anxiety, insomnia, 'exploding head', mitigating after 10/15 days. Next step: mid February, from 83mg to 75mg.

 

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  • 2 months later...
Fer787878

I'm reading a lot of stuff on here about a Lithium taper. 

I'm finding it a bit boggling , especially the bit where liquid forms come in and weighing and graduated cylinders and all that. 

I haven't started to taper yet but do you think it can be done with a good old fashioned pill cutter.

I want to simplify the process as I'm a simple person. 

I'm currently on 800. My first taper will be to 750. I cut the priadel in half. Half of 400 = 200. 

I cut the half twice more to get 50's.

I Will take 400+200+100+50= 750 and this will be my dosage for at least 2 week. 

I know it's not minutely accurate. 

But it's a relatively safe estimate. 

Is this doomed to fail? 

Am I missing something? 

Ps I don't have time to read all the posts on this thread. Forgive my ignorance. It's well below the 10% mark so I am hoping, hoping this might work going forward. 

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  • 3 weeks later...
pecanut

Hi @JanCarol

 

I'm wondering if anyone has experience or access to expertise on tapering lithium carbonate which is used in the UK?  I hope to do this once I am stable as I'm currently in withdrawal from Sertraline...but it would be good to start gathering information in preparation.

 

Many thanks

Paula

Lithium 15 years 800mg I remain on this

Many SSRIs intermittently over this period

Tapered and quit Citalopram 2017

Started Quetiapine 100mg and Sertraline 50mg 2018

Stopped Quetiapine due to daytime sedation, 4 week taper 2019

Very slow taper of Sertraline 50mg using liquid over 8 months, finishing in September 2020 on a 4mg dose.  I did not keep a record of the taper but I thought at the time I was doing it slowly and responsibly.  Clearly it was way too fast and too abrupt at the end.  

 

Currently only on Lithium at 800mg

 

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Fer787878
10 hours ago, pecanut said:

Hi @JanCarol

 

I'm wondering if anyone has experience or access to expertise on tapering lithium carbonate which is used in the UK?  I hope to do this once I am stable as I'm currently in withdrawal from Sertraline...but it would be good to start gathering information in preparation.

 

Many thanks

Paula

I presume you mean Pridel which is what we also use in Ireland. 

I'm also in the same boat and was given Lithium to treat unipolar. 

I'm going to be tapering it .

 

I have tried in the past by cutting by 10 per cent. But that didn't work for me. It gets a bit technical when u get below 10 per cent so my thinking is just taper in large amounts as I couldn't be arsed. My psych proposes a 50% cut. 

 

But I have found this site to be unresponsive. I have posted here with no reply for months. 

Reddit is good , albeit a bit random. 

But if you want a slow , measured taper, you might consider sticking with this site. Or reading the threads which can be hit and miss. 

 

You might have some luck ! 

 

 

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pecanut

Thanks Fer

 

I think I will be doing it very very slowly this time around.  Having experienced (and continuing to experience) withdrawal symptoms from a too-fast taper I'm not going to take any chances.  But I wish you luck with your fast taper and hope you get away with it.

 

Good luck whatever you decide and let us know the outcome - I really hope it works

Lithium 15 years 800mg I remain on this

Many SSRIs intermittently over this period

Tapered and quit Citalopram 2017

Started Quetiapine 100mg and Sertraline 50mg 2018

Stopped Quetiapine due to daytime sedation, 4 week taper 2019

Very slow taper of Sertraline 50mg using liquid over 8 months, finishing in September 2020 on a 4mg dose.  I did not keep a record of the taper but I thought at the time I was doing it slowly and responsibly.  Clearly it was way too fast and too abrupt at the end.  

 

Currently only on Lithium at 800mg

 

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  • 4 weeks later...

I am taking 300 mg lithium to augment Celexa which I am tapering from. Over the past six months I’ve gone from 30 mg to 13 mg of Celexa.

 

 I would like to stop the lithium now if possible but will there be any repercussions? I’ve never been manic and the lithium is only to augment the SSRI.

 

Bruci

1980s: First diagnosed with depression. Treated with a tricyclic. 1988: Switched to Prozac 20 mg after triclyclic stopped working. 1990s to 2010: On and off Prozac. Increased dose led to side effects. 2010: Work stress led to increased depression/anxiety. Tried several SSRIs but tolerated none of them. Put on Zyprexa. 2011: Work burnout and breakdown. Hospitalized for suicidal depression. Switched to Seroquel. Prozac increased to 80 mg. 2017: Started psychotherapy. Helped a lot. Switched to Celexa 40 mg and lithium 300 mg. 2019: Stopped Seroquel. Lost weight. 2020 June: Added Wellbutrin to try and correct sexual dysfunction. Could not tolerate Wellbutrin.

Taper (Lithium 300 mg maintained until off Celexa):

2020 July: Decreased Celexa to 30 mg in attempt to alleviate sexual dysfunction. Worked somewhat.

2020 August: Decreased Celexa to 20 mg. Sexual function improved but w/d effects started. 

2020 September: Maintaining Celexa at 20 mg. Experiencing w/d effects - fatigue, dysphoria, mood instability

2020 September 13: Increased Celexa to 30 mg due to w/d effects. Still on lithium 300 mg/day.

2020 October 3: Reduced Celexa to 27 mg. Started taper. 10% per month as recommended.

2020 October 18: Reduced to 24 mg.

2020 December 4: Reduced to 21 mg.

2020 December 23: Reduced to 20 mg (spacing out taper intervals due to persistent w/d effects)

 

 

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pecanut

Hi Bruci

 

I'm not an expert at all but I think it would be wise to taper the lithium very slowly and keep a careful journal of any changes and symptoms.  When I tried reducing it previously irritability was a big issue for me, but do look at the 'Tapering lithium' thread for more information.  It is a sedative medication so looking out for some level some level of activation eg agitation, irritability, anger, and other feelings and behaviours that are out of character during withdrawal might be advised.  A degree of hypomania is always a possibility, even at this relatively low dose as the dampening effect begins to lift.  You might also want to alert your close ones to look out for you during this time, and tell them what to look out for; this is helpful in case you can't discern the changes yourself, or attribute them to something else.

 

Of course I sincerely hope that you have a safe and uneventful taper of both meds.  Good luck

 

Pecanut

Lithium 15 years 800mg I remain on this

Many SSRIs intermittently over this period

Tapered and quit Citalopram 2017

Started Quetiapine 100mg and Sertraline 50mg 2018

Stopped Quetiapine due to daytime sedation, 4 week taper 2019

Very slow taper of Sertraline 50mg using liquid over 8 months, finishing in September 2020 on a 4mg dose.  I did not keep a record of the taper but I thought at the time I was doing it slowly and responsibly.  Clearly it was way too fast and too abrupt at the end.  

 

Currently only on Lithium at 800mg

 

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pecanut

I forgot to say, also, that I ran into some quite severe insomnia

Lithium 15 years 800mg I remain on this

Many SSRIs intermittently over this period

Tapered and quit Citalopram 2017

Started Quetiapine 100mg and Sertraline 50mg 2018

Stopped Quetiapine due to daytime sedation, 4 week taper 2019

Very slow taper of Sertraline 50mg using liquid over 8 months, finishing in September 2020 on a 4mg dose.  I did not keep a record of the taper but I thought at the time I was doing it slowly and responsibly.  Clearly it was way too fast and too abrupt at the end.  

 

Currently only on Lithium at 800mg

 

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Fer787878
2 hours ago, pecanut said:

I forgot to say, also, that I ran into some quite severe insomnia

I pecanut- did the insomnia last for long? And did it resolve for you? 

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Fer787878
4 hours ago, Bruci said:

I am taking 300 mg lithium to augment Celexa which I am tapering from. Over the past six months I’ve gone from 30 mg to 13 mg of Celexa.

 

 I would like to stop the lithium now if possible but will there be any repercussions? I’ve never been manic and the lithium is only to augment the SSRI.

 

Bruci

I'm on 800mg for non-BP. 

It's an extremely low dose,my psych has advised me to taper in 400's!

But, I respect anyone who wishes an extra slow taper. I was quite surprised by my psych. 

It's sounds you OK to tapering perhaps 100's every couple of weeks. 300 is well below the therapeutic dose anyway. 

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pecanut

I couldn't advise on a taper speed but I know that there is a thread here if you search Lithium taper which brings together a lot of user experience.  Slow and dead-slow are always best I think, with adequate periods b/w reductions to assess the impact of each reduction and allow things to settle .  The insomnia took months to resolve and I never completed the taper and am no expert on this

Lithium 15 years 800mg I remain on this

Many SSRIs intermittently over this period

Tapered and quit Citalopram 2017

Started Quetiapine 100mg and Sertraline 50mg 2018

Stopped Quetiapine due to daytime sedation, 4 week taper 2019

Very slow taper of Sertraline 50mg using liquid over 8 months, finishing in September 2020 on a 4mg dose.  I did not keep a record of the taper but I thought at the time I was doing it slowly and responsibly.  Clearly it was way too fast and too abrupt at the end.  

 

Currently only on Lithium at 800mg

 

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Fer787878

Just a final question. When u tapered off Li did you not sleep for MONTHS literally? Did u get any sleep at all? 0-3 hours per night or less before it finally settled? 

 

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