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Edted Son tapering Abilify


Edted

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My son is gathering (and has asked me to help) information on the relevance of half -life of the med being tapered to the tapering schedule. He is trying to find a way off abilify. This drug has a very long half-life (96 hours, longer if you are a slow metabolizer... up to 145 hours). If it takes you nearly a month just to arrive at a new steady level, the brain never gets a rest period from the withdrawal. His last attempt at withdrawal was disastrous at .8 (yes that's point 8 mg). He had been tapering at .1 mg every two weeks. That turned out to be too fast. I am familiar with the "no more than 10% of last dose" rule, but wonder if monthly reductions are right for a drug with such a long half-life.

Thank you,

Ed

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Good question, Ed.

 

What dosage of Abilify is your son taking? Abilify is dosed at deceptively low doses, leading people to think they can just quit, the dose is so small. But it's a powerful drug, and proportionate tapering is called for.

 

Long half-life drugs are supposed to be easier to taper, the idea being the blood level of the drug gradually declines over time, giving the nervous system time to adjust. Some such as Prozac are even mistakenly called "self-tapering."

 

But as you and your son have observed, what this means is withdrawal symptoms are delayed, and you might be far down the road, or even off the drug, by the time you can get feedback from your body that you've gone too fast.

 

Still, a long half-life drug can be tapered. We suggest a trial 10% taper per month for the first 2 months to see if one's body can tolerate that much of a decrease. If a person is especially sensitive to dosage decreases, he or she could reduce by a smaller amount and hold longer for the observation period.

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

All postings © copyrighted.

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Alto Strata

Thank you for the quick reply. He is currently at 5mgs. Following the last attempt at w/d in October he was hospitalized, injected with Haldol, then put on Olanzapine and Lithium. When he was discharged, his psych put him on 15mgs (I think, I could check)of Abilfy and stopped the other meds. He reduced to 5mgs quickly and has been at that dose since January. He is only now stabilizing. He has alway found the drop to 5mgs to be relatively uneventful (even getting to 4mgs at .2 decreases biweekly has gone well in the past). He had an infection a couple of weeks ago and was on antibiotics for 10 days. With a psychosis in October, then the flu, the changes in meds and then the antibiotics; he won't make any changes till he feels solid for a month. The remaining symptoms of myoclonic jerks, malaise and anxiety are just mending now.

Thank you,

Ed

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Although this is somewhat to the side; people have asked in other threads on this site about useful tests. Most medications are largely metabolized by the liver enzyme CYP2D6. There are enormous differences in plasma levels of individuals who have different genetic profiles for production of this enzyme and the variant profiles are common. Specifically in reviewing plasma levels of abilify for different genotypes for CYP2D6 a variance was found of 60x for poor metabolizers vs. fast metabolizers. Much of what is termed hyper-sensitivity may be the result of exposure to the drug far in excess of what has ever been tested. The test for CYP2D6 exists but costs nearly $1,000, is rarely covered by insurance, and in my state cannot be obtained without prescription. Following an FDA inquiry about the possible wisdom of having this test done prior to prescription, the APA allowed a comment period from its membership and then determined that because practitioners determine dosage based on observed effects, the test was unnecessary.

Ed

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I'm sorry your son was hospitalized. That sounds like a tough thing to have gone through. I'm glad he is out and back in his home. I think it's very stressful for parents dealing with doctors and medications. I know years ago my father said he felt like he had to be a detective or maybe he said cop but, whatever he said, he found the peripherals very stressing.

 

Hang in there.

 

I hope your son is well recovered from the flu as well.

 

best,

Alex

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Alex. Thank you for your kind words and well wishes. My son is 27 and living at home. He has had more than a dozen hospitalizations since the nightmare began in 2004. Because the withdrawals have been so severe, it is with the very greatest caution that he is considering another attempt to get off the meds. It is that caution that prompts my questions. All information on Abilify withdrawal will be greatly appreciated.

Be well,

Ed

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  • Moderator Emeritus

Hi Ed,

 

I'm glad your son has such a good and intelligent dad. I know how stressful this can be for you because my mom was hospitalized too many times for me to count. It started when I was 10 years old. I didn't understand at all, just knew every time she got 'sick', she had left her medicine off again.

 

I wish I had kept a journal and knew how many different meds she had been on. The only thing any of us knew back then was that "she had to take medicine for the rest of her life". There was no Internet so we just didn't know. Those were sad times for me and I could see, even as a child, how stressful it was for my dad.

 

I wish the best for you and your son,

Tezza

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Thank you Tezza. I am so sorry that you and your family went through the series of catastrophes that unsuccessful withdrawal attempts cause. I wish I had the intelligence or educational background to fully understand what scientific articles may offer as far as a better understanding of the nature of withdrawal problems (and, consequently, how to minimize them). This board appears to have the largest amount of information on withdrawal on the web. It also has managed to retain meaningful and constructive narrative. I look forward to learning from the folks here and contributing whatever information I may have found.

All the best,

Ed

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  • Administrator

See tips for tapering Abilify here http://survivingantidepressants.org/index.php?/topic/1896-tips-for-tapering-off-abilify-aripiprazole/

 

Edted, it seems your son should use the liquid for tapering very, very gradually, with frequent holds so he doesn't become destabilized.

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

All postings © copyrighted.

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  • Moderator Emeritus

welcome Ed - your son is lucky to have you on board to help with his withdrawal - at 17 he has a great chance of a life without psychiatric drugs with the right support. Have your read Anatomy of an Epidemic? It was an eye opener for me regarding the use of psychiatric medicines and the increase in psychiatric diagnoses and dysfunction.

Started in 2000 - On 150mg most of the time, (but up to 225mg at highest dose for 6 months in the beginning)
Reduced off easily first time - but got depressed (not too much anxiety) 6 months later
Back on effexor for another 9 months.
Reduced off again with no immediate w/d - suddenly got depressed and anxious ++ again 3 or 4 months later.
Back on effexor - this time for 3 years
Reduced off over a month - 6 weeks later terrible anxiety - back on.
Rinse and repeat 4 more times - each time the period before the anxiety comes back got shorter and shorter
Jan - July 2012 75mg down to 37.5mg;, 8/3/12 - 35mg. 8/25/12 - 32mg. 9/11- 28mg, 10/2 - 25mg, 10/29 - 22mg, 11/19 - 19.8mg; 12/11 - 17m,
1/1- 15.5mg; 1/22 -14mg, 2/7 14.9mg, 2/18 - 17.8mg - crashed big time: back to 75mg where i sat for 2 years....

4th  March 2015 - 67.5mg;   31st March - 60mg;  24th April - 53mg; 13th May - 48mg; 26th May - 45mg;  9th June - 41mg; 1 July- 37.5mg; 20 July - 34mg; 11 August - 31mg; 1st Sept - 28mg;  1st Dec - 25.8mg;  28th Dec - 23.2mg; 23rd Jan-21.9mg; Feb 7th- 21mg; March 1st - 20.1mg, March 30th - 18mg

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Alto Strata, I certainly agree. He wa using the liquid the last time when he got down to . 8mgs, but he was only holding two weeks and was decreasing at .1mgs each cut without being mindful of the 10% rule. He was also using very bad advice received at a popular nutritionally based site that you should endure symptoms to the extent that you are able. If there is anything that I would pass along from his experience it would be, "Don't tough it out. Reinstate and slow down".

Peggy, thank you. He is 27 (rather than 17), but he does have many years to look forward to.

All the best,

Ed

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Peggy:

I forgot to mention that I did read Anatomy (well sections of it at least). I hope it helps people to avoid the disaster of psychotropic drugs, or to find this site if they have already started taking them.

Regards,

Ed

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Alto Strata

I know receptor occupancy isn't the whole story when it comes to a drugs effects, but I see a lot of comments from people that they thought the taper (of Abilify) was finished because they were at a low dose. Pet scan study in 2002 showed D2receptor occupancy after two weeks on .5mgs (half a mg) at 45%. This stuff is potent.

Thanks for the soapbox,

Ed

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I used to take abilify and I've read about it in APA Psychiatry Textbook and countless other places. I don't understand what it does exactly, after much reading, with any confidence.

 

One lament of many in the mental health profession (psychiatrists and pharmascolds alike) is that we really don’t know enough about how our drugs work. Sure, we have hypothetical mechanisms, like serotonin reuptake inhibition or NMDA receptor antagonism, which we can observe in a cell culture dish or (sometimes) in a PET study, but how these mechanisms translate into therapeutic effect remains essentially unknown.

 

As a clinician, I have noticed certain medications being used more frequently over the past few years. One of these is Abilify (aripiprazole). I’ve used Abilify for its approved indications—psychosis, acute mania, maintenance treatment of bipolar disorder, and adjunctive treatment of depression. It frequently (but not always) works. But I’ve also seen Abilify prescribed for a panoply of off-label indications: “anxiety,” “obsessive-compulsive behavior,” “anger,” “irritability,” and so forth. Can one medication really do so much? And if so, what does this say about psychiatry?

....

Abilify is a unique pharmacological animal. Like other atypical antipsychotics, it binds to several different neurotransmitter receptors; this “signature” theoretically accounts for its therapeutic efficacy and side effect profile. But unlike others in its class, it doesn’t block dopamine (specifically, dopamine D2) or serotonin (specifically, 5-HT1A) receptors. Rather, it’s a partial agonist at those receptors. It can activate those receptors, but not to the full biological effect. In lay terms, then, it can both enhance dopamine and serotonin signaling where those transmitters are deficient, and inhibit signaling where they’re in excess.

 

Admittedly, that’s a crude oversimplification of Abilify’s effects, and an inadequate description of how a “partial agonist” works. Nevertheless, it’s the convenient shorthand that most psychiatrists carry around in their heads: with respect to dopamine and serotonin (the two neurotransmitters which, at least in the current vernacular, are responsible for a significant proportion of pathological behavior and psychiatric symptomatology), Abilify is not an all-or-none drug. It’s not an on-off switch. It’s more of a “stabilizer,” or, in the words of Stephen Stahl, a “Goldilocks drug.”

 

Thus, Abilify can be seen, at the same time, as both an antipsychotic, and not an antipsychotic. It’s both an antidepressant, and not an antidepressant. And when you have a drug that is (a) generally well tolerated, (B) seems to work by “stabilizing” two neurotransmitter systems, and © resists conventional classification in this way, it opens the floodgates for all sorts of potential uses in psychiatry.

 

....

 

But even if these trials are negative, my prediction is that this won’t stop doctors from prescribing Abilify for each of the above conditions. Why? Because the mechanism of Abilify allows for such elegant explanations of pathology (“we need to tune down the dopamine signal to get rid of those flashbacks” or “the serotonin 1A effect might help with your anxiety” – yes, I’ve heard both of these in the last week), that it would be anathema, at least to current psychiatric practice, not to use it in this regard.

 

This fact alone should lead us to ask what this says about psychiatry as a whole. The fact that one drug is prescribed so widely—owing to its relatively nonspecific effects and a good deal of creative psychopharmacology on the part of doctors like me—and is so broadly accepted by patients, should call into question our hypotheses about the pathophysiology of mental illness, and how psychiatric disorders are distinguished from one another.

 

http://thoughtbroadcast.com/2011/09/13/how-abilify-works-and-why-it-matters/

 

My sense is that honest psychiatrists lack confidence that they really understand, with any exactness, how the drug works as well.

 

best,

Alex

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Alex:

Please take anythIng I say within the context of my lack of a medical background. I would add to the glowing reviews of Abilify for its "goldilocks effects" the following cautions:

Although the throughput of aripiprazole is 60% of the natural ligand dopamine at the D2 receptors, the throughput is primarily tonic rather than phasic. Phasic throughput is robust (kind of like a spark plug in a car). Tonic throughput is more of a dribble of effect (think of a spark plug that is leaking through). I find nothing in the literature to elucidate what the results of such a change might be. The reviews do little to expand on the antagonistic effects of aripiprazole on the 5 ht2 receptor (to which it binds very strongly) beyond a suggestion that this will have a "knock on" effect to improve dopamine throughput. If anyone cares to read about hdac2 inhibition in the current scientific articles, he/she will be struck by the number of ailments that are now thought to be a result of or exacerbated by hdac2 activation (cancer, Alzheimer's, schizophrenia, etc). All atypical antipsychotics, by virtue of 5ht2 antagonism cause hdac2 over activation. Am I the only one who sees this as a reason to be alarmed about atypical antipsychotic use? I pointed to the Mt Sinai report in a forum on MIA for discussion with links to a few articles on this (not the least significant of which ties hdac2 activation to the elevation of dopamine receptors to the high state by wiping out expression of mglu2). Someone, please tell me why placing someone in a state of aberrant d2 high levels is not a psychosis waiting to happen. In connection with withdrawal I looked for information on how long after withdrawal, one might expect the epigenetic repression of mglu2 to resolve. I have found nothing. I suspect that, at least as far as atypicals, it suggests vulnerability beyond the expected d2 recovery time.

I hope I haven't made too big a hash of this explanation, but it isn't just idle speculation. My son presumably not the only one who agonizes over how long after he is med free will he still be more "at risk" than if he had never taken this crap.

Ed

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  • Administrator

Ed, we believe here that you should taper at a rate that symptoms are minimized, definitely not to "tough it out."

 

If withdrawal symptoms are any more than mild and last longer than 3 days after a decrease, you've gone too fast.

 

The absolute amount of each decrease should get progressively smaller at a 10% (or less) proportion to the last dosage.

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

All postings © copyrighted.

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Hi Ed-

I'm not a neuroscientist, nothing of the sort. I regret my own experience with antypical antipsychotics and I could not in good conscience advocate their use to a peer. I hope I didn't give off the wrong impression.

 

best,

Alex

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Alto Strata:

Message understood. I greatly regret all my son has had to go through because I did not know before.

With gratitude,

Ed

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Alex:

I hope that I didn't seem to suggest that you had come across as a neuroscientist. I was only trying to let any readers know of my limitations. You came across as a caring person offering advice and it was/is appreciated. I have little experience with the abbreviated format of postings and find difficulty conveying the tone I intend.

All the best,

Ed

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You're welcome, Ed.

 

Please allow me to point out that withdrawal not only affects target receptors, but the entire neurological and hormonal environment that has accommodated to the action of the drug. Effectively, this creates an artificial homeostasis dependent on continued input of the drug.

 

Disrupting the homeostasis is what causes withdrawal symptoms.

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

All postings © copyrighted.

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No worries Ed. I'm really sorry that you and your family are having to endure this. Hang in there.

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Thanks again Alex and Alto Strata. Please continue to post your insights. Alto Strata, I am beginning to question a lot of the advice given elsewhere regarding supplements in light of the body's own attempts to resolve the disruption of the drug and again in withdrawal. I suspect that in general supplements are just providing more disruption. My son has expressed a wish to quit smoking to improve his ability to exercise. Do you have any opinion on the benefit of quitting smoking while withdrawing from antipsychotics? Alex, hanging in there is a "fer sure". We just need to remember that informed beats tough when it comes to withdrawal.

Well wishes to you both,

Ed

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  • Administrator

We advise being very conservative with supplements for the reasons you've surmised. No supplement program replaces the need for careful tapering, and we don't recommend any of them.

 

We've got topics discussing individual supplements in the Symptoms and Self-care forum.

 

General good health supports resilience during tapering. Some supplements can assist this, but eating a fresh, balanced diet; avoiding artificial ingredients, stimulants, and alcohol; and keeping regular hours are more important.

 

If your son can cut down smoking gradually without feeling too terrible, that might help, too.

 

He doesn't have to get into condition with strenuous exercise; a habit of moderate, regular exercise is beneficial.

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

All postings © copyrighted.

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Thanks Alto Strata. I know much of what I ask about may seem obvious to you, but I really know that little. I have read all Abilify posts on this site and am working my way through antipsychotic posts and more general ones.

With appreciation,

Ed

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There's a dearth of good information out there, Ed, I don't blame you one bit.

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

All postings © copyrighted.

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  • Moderator Emeritus

Ed, we believe here that you should taper at a rate that symptoms are minimized, definitely not to "tough it out."

 

If withdrawal symptoms are any more than mild and last longer than 3 days after a decrease, you've gone too fast.

 

The absolute amount of each decrease should get progressively smaller at a 10% (or less) proportion to the last dosage.

 

Agreed.

 

With a long half-life drug I think it's important to take periodic long holds to allow for that lag time effect, and you need to hold the moment symptoms appear, rather than wait until they become intolerable.

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

May 2021            7                       0.01                  0.0037                1

Feb 2022            6                      0!!!                     0.00167               0.98                2.5 mg Ambien

Oct 2022       4.5 mg Lamictal    (off Celexa, off Xanax)   0.95 Valium    Ambien, 1/4 to 1/2 of a 5 mg tablet 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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Thank you Alto Strata and Rhi. What would you consider a long hold? When my son is ready to start again (presumably in mid-April when he has been feeling stable for at least a month, and after his appointment with his shrink to get back on liquid Abilify), he or I will post his planned tapering schedule. We would certainly appreciate comments on it.

Gratefully,

Ed

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  • Moderator Emeritus

Thank you Alto Strata and Rhi. What would you consider a long hold? When my son is ready to start again (presumably in mid-April when he has been feeling stable for at least a month, and after his appointment with his shrink to get back on liquid Abilify), he or I will post his planned tapering schedule. We would certainly appreciate comments on it.

Gratefully,

Ed

 

It really depends on his symptoms and how it's going for him, and how big the cuts are that you are making each time; but for me a long hold is two to eight weeks. (I make very, very small changes at a time.)

 

I would recommend starting with a small cut (2-5%) and waiting a week or two, then maybe another and waiting another week or two, then maybe a third cut (on the smaller end), and then holding for a month. During all of that time I'd keep track of symptoms, ranking them daily on a scale of 1 to 5 or something like that. At the start of a taper I recommend going slowly and cautiously and paying close attention to how your symptoms respond. You're gathering the data you need--about your own body (or in this case, your son's)--to adjust your own taper as you go along.

 

Adjusting a taper by one's own symptoms is, I think, a much safer way to go than to follow some kind of preplanned calendar schedule.

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

May 2021            7                       0.01                  0.0037                1

Feb 2022            6                      0!!!                     0.00167               0.98                2.5 mg Ambien

Oct 2022       4.5 mg Lamictal    (off Celexa, off Xanax)   0.95 Valium    Ambien, 1/4 to 1/2 of a 5 mg tablet 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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  • Moderator Emeritus

You're welcome, Ed.

 

Please allow me to point out that withdrawal not only affects target receptors, but the entire neurological and hormonal environment that has accommodated to the action of the drug. Effectively, this creates an artificial homeostasis dependent on continued input of the drug.

 

Disrupting the homeostasis is what causes withdrawal symptoms.

 

So much said, with so few words. The crux of the biscuit.

 

Somehow when I try to say the same thing it comes out about three pages long.

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

May 2021            7                       0.01                  0.0037                1

Feb 2022            6                      0!!!                     0.00167               0.98                2.5 mg Ambien

Oct 2022       4.5 mg Lamictal    (off Celexa, off Xanax)   0.95 Valium    Ambien, 1/4 to 1/2 of a 5 mg tablet 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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My adult son is still stabilizing from his last w/d attempt. Every w/d attempt in the past has produced florid psychosis (never psychotic prior to meds). Although this site has helped us understand what was wrong with the prior w/d attempts, the major impediment to trying again is fear. His last attempt produced extreme violence (he is, by nature, one of the gentlest people I've ever known). Does anyone know how to eliminate the risk? The meds (antipsychotics) have already hurt him so much, physically and mentally; he really doesn't see continuing them as an option, but he will not chance killing someine. We tried to find a place where he could be safe for the years that w/d will take: there is no such place. I know many people here suffer terribly in withdrawal, and I am not minimizing their suffering, but choosing to risk yourself is a different choice than choosing to risk others. He can't be the only one that faces this dilemma, but I have never seen this problem discussed. For a while he could get by with the hope that a solution would be found some day, but that hope is not sustainable.

Edted

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Hi, Ed.

 

Going off by very tiny amounts might make your son feel in control of his taper.

 

What drugs and dosages is he taking now?

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

All postings © copyrighted.

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Alto Strata:

He is currently on 5mgs of Abilify. I see the reasoning in the taper protocols outlined on this site. If it weren't for the extreme violence aspect of his last withdrawal, he /we would be devoted to another attempt. I had thought that I (or his psychiatrist or his psychologist) would have seen that all hell was about to break loose before it happened. My son was slipping into psychosis, but was hiding what was going on. The delusions eroded his trust in us, so he did not say anything about what was happening to him. I don't want to be specific in a public forum about the final events before he was taken by force to the hospital, but it was only luck that prevented an unthinkable tragedy.

Ed

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No need to disclose further, Ed.

 

People are confused by the low dosing of Abilify. They think they're taking a "baby dose" and go off too quickly, but it's a powerful drug, which is why it's dosed so low.

 

You might try decreases of 5% (.25mg) to begin, or even 0.10mg. The idea is to make the decreases so small his nervous system doesn't recognize the change.

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

All postings © copyrighted.

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Alto:

Yes, the wisdom of tinier decreases seems valid. His last attempt he was reducing by .1mg every two weeks and that was too fast. I am still stuck with the problem of , "what if it goes wrong?" Maybe I am asking a question that has no good answer.

Thanks,

Ed

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A reduction every two weeks is not enough time to catch an emerging symptom pattern.

 

Since Abilify has such a very long half-life (75 h (aripiprazole) and 94 h (dehydroaripiprazole)), after 2 weeks a decrease might just be registering with the nervous system. If you add another decrement on top of that, you'll have reduced too fast to adjust the rate of taper should there be any withdrawal symptoms from the first decrease.

 

You need to work together to monitor symptoms. If symptoms start to show up, the taper is too fast and you need to either hold or back up slightly in dosage and stabilize, then proceed with smaller decrements.

 

When your son tried to taper by 0.10mg before, how long did it take for symptoms to show up?

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

All postings © copyrighted.

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Edted,

I just wanted to add that you and your son are not alone...it's simply not something most people are comfortable talking about in a public forum, but violence creeps in to a lot of people's withdrawals...I know a lot of folks who had to battle extreme rage with benzos too that led to violence in some instances. It doesn't just happen with antipsychotics. There are varying degrees of risk of course depending on the individual and it sounds like great caution is warranted in the case of your son and it's wonderful that he has you to support him.

 

And yes, tiny micro-cuts is what I'd recommend too and a willingness to take as long as it takes.

 

I'm sorry you're having to deal with this.

Everything Matters: Beyond Meds 

https://beyondmeds.com/

withdrawn from a cocktail of 6 psychiatric drugs that included every class of psych drug.
 

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