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After reinstating or updosing, how long to stabilize?


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Has anyone become unstable after a long (4 month) hold? How does reinstating work in that case? I was stable for months and holding because I was trying supplements. I got off all supplements 2 weeks ago, but there's been minimal improvement only. My next option is reinstating a bit.

 

I'm worried that if I reinstate after a long hold, I might destabilize my system and/or make future tapers harder.

  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivingantidepressants.org/index.php?/topic/6012-newbeginning-my-withdrawal-story/?p=267313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression; tried updosing to 17 beads Feb 7 but anxiety got worse; went down to 16 beads

    May 2017: Anxiety improved; severe depression continues

  • September 2017: finally stabilized!!!!!! 09/07/2017-12/31/2017: hold

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Now that its been 19 months since my cold turkey from Effexor, Im about 85% recovered. As you know im now tapering slowly off of Effexor from when I reinstated in my 3rd month of the cold turkey. Ho

The autonomic dysregulation caused by the first withdrawal was only partly corrected by medication. Going back on medication does not guarantee that withdrawal damage will be "fixed."

I think Rhi's answer pretty much nailed it. I've been at this game for years now, and had a range of experiences reinstating/updosing, in the past I've been able to reinstate to full dose after months

reachingforthestars

I updosed after holding about a month from 4mg to 5mg and I had back reaction to it(akathisia, insomnia ect.). I also updosed from 2.6mg to 2.8mg after holding a week and had back reaction (akathisia). I never tried to hold for 4 days to stabilize and I think it is dangerous to try to hold if you get bad reaction. Also I think that there cannot be 4 days rule since different drugs have different half lives. I think that bad reaction means serotonin syndrome since the symptoms are so alike. Maybe receptors have become more sensitive and that's why even little updosing means big stimulation in the brain?

Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 

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On the first instance of updosing, perhaps it was too much of an increase? When you had been holding for a month, I assumed you were in withdrawal?
 
On the second updosing, you didn't increase a lot, but I wonder how you were before that? Looking at your signature, you've been going rather fast. If you've been having withdrawal and kept cutting, your reactions to updosing may just be the same withdrawal that you had before, which the reinstatement didn't help. Sometimes if we get very unstable, reinstating doesn't work or can make us worse.
 
In my case, I've updosed several times and it always helped me stabilize. However, I never had withdrawal without cutting. It's been 4 months on the same dose so I'm not sure how my body will react if I updose. I don't even understand why I'm having withdrawal after 4 months of being stable right after another updose. My last change was an updose, not a cut! And it was over 5 months ago. I've been stable for 3 months and the last month had issues.

  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivingantidepressants.org/index.php?/topic/6012-newbeginning-my-withdrawal-story/?p=267313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression; tried updosing to 17 beads Feb 7 but anxiety got worse; went down to 16 beads

    May 2017: Anxiety improved; severe depression continues

  • September 2017: finally stabilized!!!!!! 09/07/2017-12/31/2017: hold

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reachingforthestars

I know the difference between Wd symptoms and bad reaction. It is very clear to me since I know my body and they are very different kind of symtoms. Also the bad reaction is immediate akathisia after 1 or 2 hours after the dose of SSRI. I never have had akahisia as WD symptom.

Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 

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I understand. It can also be a side effect of the med, which would show at higher doses. I'm not saying it was not a reaction to updosing. I just thought it could be other things too.

 

When that happened to you, I assume you decreased and the reaction resolved. But what about the withdrawal symptoms that you were trying to address with the updose? What happened to those symptoms when you updosed and then decreased again?

  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivingantidepressants.org/index.php?/topic/6012-newbeginning-my-withdrawal-story/?p=267313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression; tried updosing to 17 beads Feb 7 but anxiety got worse; went down to 16 beads

    May 2017: Anxiety improved; severe depression continues

  • September 2017: finally stabilized!!!!!! 09/07/2017-12/31/2017: hold

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reachingforthestars

I didn't have much other WD symptoms than extreme muscle weakness. At one point I couldn't get out house because of the muscle weakness. Mentally I was very emotional and crying and laughing a lot and it felt good to feel again so much. There were some minor other physical symptoms but nothing bigger except that weakness. I was sleeping a lot like 14 hours a day and i was very relaxed, but due to weakness i wanted to try updosing...

 

Updosing made me extremely agitated added insomnia alkathisia and anhedonia and didn't help with muscle weakness at all. It helped when I reduced my dose to previous and akathisia lifted but anhedonia is still there and my sleep is still lighter that before updosing. 

 

Very very slowly muscle weakness has alleviated a lot and now i can walk 1 hour a day.

Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 

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I see. So for you updosing led to bad results and some of those bad symptoms have not resolved completely even months later. That scares me :(

 

Was the weakness there at all before you started tapering (and got worse when tapering)?

 

The times when I updosed I had unbearable symptoms like bad anxiety that lasted months, and the updosing helped. But right now the situation is more uncertain.

 

Thanks for sharing your experiences. I appreciate it :)

  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivingantidepressants.org/index.php?/topic/6012-newbeginning-my-withdrawal-story/?p=267313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression; tried updosing to 17 beads Feb 7 but anxiety got worse; went down to 16 beads

    May 2017: Anxiety improved; severe depression continues

  • September 2017: finally stabilized!!!!!! 09/07/2017-12/31/2017: hold

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reachingforthestars

No, before tapering I was in very good shape physically, athletic swimming and jogging.

Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 

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Serotonin Syndrome is a very serious condition caused by toxic level of serotonin in the brain.  It is NOT caused by a small updose when a person is taking a minuscule dose. Because of the nature of the drugs WD symptoms, side effects and serotonin syndrome will have some things in common, but WD symptoms and side effects are not serotonin syndrome.

 

Half life is only one small factor in determining blood level steady state.  The 4 day rule takes into account half life, absorption rates, metabolic rates, dosing schedule, the aggregate experience of thousands of case histories and many other factors. After an increase in dosage it can take several weeks to many months to stabilize. During that time it is recommended that a person not change dose until they have stabilized. To do so increases the risk of further destabilization.  Also note that stabilization does not mean symptom free.  It means that the symptoms have evened out to a consistent level with no big swings either direction.

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

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

Current dose 0.000mg 04-15-2017

 

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

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Serotonin Syndrome is a very serious condition caused by toxic level of serotonin in the brain.  It is NOT caused by a small updose when a person is taking a minuscule dose. Because of the nature of the drugs WD symptoms, side effects and serotonin syndrome will have some things in common, but WD symptoms and side effects are not serotonin syndrome.

 

Half life is only one small factor in determining blood level steady state.  The 4 day rule takes into account half life, absorption rates, metabolic rates, dosing schedule, the aggregate experience of thousands of case histories and many other factors. After an increase in dosage it can take several weeks to many months to stabilize. During that time it is recommended that a person not change dose until they have stabilized. To do so increases the risk of further destabilization.  Also note that stabilization does not mean symptom free.  It means that the symptoms have evened out to a consistent level with no big swings either direction.

 

 

Brass,

 

If you were stable after a several month hold, can you still benefit from updosing, or is it a bad idea?

  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivingantidepressants.org/index.php?/topic/6012-newbeginning-my-withdrawal-story/?p=267313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression; tried updosing to 17 beads Feb 7 but anxiety got worse; went down to 16 beads

    May 2017: Anxiety improved; severe depression continues

  • September 2017: finally stabilized!!!!!! 09/07/2017-12/31/2017: hold

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  • Moderator

If you're stable then why would you want to be updosing?

 

"My last change was an updose, not a cut! And it was over 5 months ago. I've been stable for 3 months and the last month had issues."

 

If your symptoms are starting to kick up after several months of stability, that would indicate the beginnings of a tolerance issue and the best thing to do would be starting a slow gentle taper. Up dosing would just add fuel to the tolerance issue.  It's counter intuitive but the best way out of tolerance is to decrease.

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

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

Current dose 0.000mg 04-15-2017

 

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

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If you're stable then why would you want to be updosing?

 

"My last change was an updose, not a cut! And it was over 5 months ago. I've been stable for 3 months and the last month had issues."

 

If your symptoms are starting to kick up after several months of stability, that would indicate the beginnings of a tolerance issue and the best thing to do would be starting a slow gentle taper. Up dosing would just add fuel to the tolerance issue.  It's counter intuitive but the best way out of tolerance is to decrease.

 

I thought about that, but some of the other moderators don't believe in "tolerance withdrawal". They believe if this is withdrawal, then cutting more will cause more instability.

 

If I don't stabilize within a week or two, I'll try cutting a little. If I get worse then will take it from there.

 

Thanks for the advise!

  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivingantidepressants.org/index.php?/topic/6012-newbeginning-my-withdrawal-story/?p=267313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression; tried updosing to 17 beads Feb 7 but anxiety got worse; went down to 16 beads

    May 2017: Anxiety improved; severe depression continues

  • September 2017: finally stabilized!!!!!! 09/07/2017-12/31/2017: hold

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reachingforthestars

Serotonin Syndrome is a very serious condition caused by toxic level of serotonin in the brain.  It is NOT caused by a small updose when a person is taking a minuscule dose. Because of the nature of the drugs WD symptoms, side effects and serotonin syndrome will have some things in common, but WD symptoms and side effects are not serotonin syndrome.

 

Half life is only one small factor in determining blood level steady state.  The 4 day rule takes into account half life, absorption rates, metabolic rates, dosing schedule, the aggregate experience of thousands of case histories and many other factors. After an increase in dosage it can take several weeks to many months to stabilize. During that time it is recommended that a person not change dose until they have stabilized. To do so increases the risk of further destabilization.  Also note that stabilization does not mean symptom free.  It means that the symptoms have evened out to a consistent level with no big swings either direction.

 

"Extremely high levels of serotonin can cause a condition known as serotonin syndrome, with toxic and potentially fatal effects. In practice, such toxic levels are essentially impossible to reach through an overdose of a single antidepressant drug, but require a combination of serotonergic agents, such as an SSRI with an MAOI.[67] The intensity of the symptoms of serotonin syndrome vary over a wide spectrum, and the milder forms are seen even at nontoxic levels."

 

So the intensity of serotonin syndrome can vary. I also read that it is impossible to test serotonin syndrome anyway(like take labs) so it only can be pointed out from symptoms(agitation, akathasia, imsomnia ect.). If I understood correctly it all depend from receptors and how sensitive they are. When we start to taper it is impossible to know what kind of changes is happening to our receptors. If we start getting more and more emotions it sounds to me like receptors are waking up and becoming more sensitive  so if you in that condition updose the stimulus can be so much bigger than in previous state where the receptors have been more numbed and you end up on toxic levels of serotonin. 

 

This is what mm100 wrote in an other thread:

 

"it seems to me that the problems may start due to the UPREGULATION of the serotonin receptors after discontinuing the drug, and this is also why taking the drug again will not help as the serotonin system is far too sensitized (upregulated)"

Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 

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Serotonin Syndrome is a very serious condition caused by toxic level of serotonin in the brain.  It is NOT caused by a small updose when a person is taking a minuscule dose. Because of the nature of the drugs WD symptoms, side effects and serotonin syndrome will have some things in common, but WD symptoms and side effects are not serotonin syndrome.

 

Half life is only one small factor in determining blood level steady state.  The 4 day rule takes into account half life, absorption rates, metabolic rates, dosing schedule, the aggregate experience of thousands of case histories and many other factors. After an increase in dosage it can take several weeks to many months to stabilize. During that time it is recommended that a person not change dose until they have stabilized. To do so increases the risk of further destabilization.  Also note that stabilization does not mean symptom free.  It means that the symptoms have evened out to a consistent level with no big swings either direction.

 

"Extremely high levels of serotonin can cause a condition known as serotonin syndrome, with toxic and potentially fatal effects. In practice, such toxic levels are essentially impossible to reach through an overdose of a single antidepressant drug, but require a combination of serotonergic agents, such as an SSRI with an MAOI.[67] The intensity of the symptoms of serotonin syndrome vary over a wide spectrum, and the milder forms are seen even at nontoxic levels."

 

So the intensity of serotonin syndrome can vary. I also read that it is impossible to test serotonin syndrome anyway(like take labs) so it only can be pointed out from symptoms(agitation, akathasia, imsomnia ect.). If I understood correctly it all depend from receptors and how sensitive they are. When we start to taper it is impossible to know what kind of changes is happening to our receptors. If we start getting more and more emotions it sounds to me like receptors are waking up and becoming more sensitive  so if you in that condition updose the stimulus can be so much bigger than in previous state where the receptors have been more numbed and you end up on toxic levels of serotonin. 

 

This is what mm100 wrote in an other thread:

 

"it seems to me that the problems may start due to the UPREGULATION of the serotonin receptors after discontinuing the drug, and this is also why taking the drug again will not help as the serotonin system is far too sensitized (upregula

 

I didn't know there were different degrees of Serotonin Syndrome. Since Serotonin can't be measured reliably, it is virtually impossible to differentiate an adverse reaction to an updose/reinstatement from mild Serotonin Syndrome, if the symptoms of the reaction mimic Serotonin Syndrome.

 

I don't think one can get Serotonin Syndrome at the low doses we are on when tapering. Even if the receptors are upregulating, if you didn't get Serotonin Syndrome on the full dose before any of your receptors were downregulated, you shouldn't get it at lower doses or with half of your receptors upregulated again.

  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivingantidepressants.org/index.php?/topic/6012-newbeginning-my-withdrawal-story/?p=267313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression; tried updosing to 17 beads Feb 7 but anxiety got worse; went down to 16 beads

    May 2017: Anxiety improved; severe depression continues

  • September 2017: finally stabilized!!!!!! 09/07/2017-12/31/2017: hold

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reachingforthestars

I know that my conclusions are only speculations since no one knows what really is happening in our brains and to our receptors during taper and during withdrawal. I believe that my receptors have changed so much from what they used to be before ten years on SSRI that it is now possible for me to get serotonin toxicity on lower doses. For example in insulin resistance it doesn't matter are the insulin levels normal it only matters are the insulin receptors sensitive enough to insulin. But if the insulin receptors are sensitive then you can get easily poisoning even from a little too high level of insulin. So in a way I think that SSRI can make serotonin resistant (serotonin) receptors and nothing happens even on high doses (except treatment resistant depression eventually).

Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 

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I agree with RFTS from first hand experience about how the body reacts to these drugs after a bad reaction, even I don't know much about the science behind it. I never had problems taking lexapro at high doses until lately My body feels the poison effects of even a tiny drop. The whole situation changed completely. It doesn't matter what we call it, it's very true indeed.

Drug free Sep. 23 2017

2009 Mar.: lexapro 10mg for headache for 2 weeks.

2009-2012: on and off 1/4 to 1/3 of 10mg

2012 June--2013 Jan,: 1/4-1/3 of 10mg generic, bad jaw pain

2013 Jan-Mar: 10 mg generic. severe jaw and head pain;

2013 Mar--Aug. started tapering (liquid ever since) from 10 to 5 (one step) then gradually down to 2.25 mg by July. first ever panic attack, severe head/jaw pain

2013 Aug.: back to 2.75 mg; Nov: back to Brand Lex. 2.75mg -- 3mg,

2014 June: stopped PPI, head pressure/numbness. up-dosed 4.5mg, severe reaction mental symptoms added on

2014 Aug--2015 Aug: Micro taper down to 3.2mg, .025mg (<1%) cut holding 2-3 weeks.

2015 Aug 15th, Accidental one dose of 4.2mg. worsening brain non-functional, swollen head, body, coma like, DR

2016 Feb., started dosing 10am through 11 pm everyday 2/13--3.2mg, 3/15-- 2.9mg, 4/19-- 2.6mg, 6/26--2.2mg, 7/22 --1.9mg, 8/16--1.8mg,8/31--1.7m g, 9/13--1.6mg, 9/27--1.5mg, 10/8--1.4mg, 10/14--1.3mg, 11/1--1.2mg, 11/29--1.1mg, 12/12--1mg, 12/22--0.9mg

2017: 1/7--0.8mg, 1/15--0.7mg, 1/17--0.6mg, 1/20--0.52, 1/21--0.4mg, 1/22--0.26, 1/23--0.2, 2/13--0.13mg, 2/20--0.06mg, 3/18--0.13mg, 6/1--0.12mg, 7/6--0.1mg, 7/14--0.08mg, 8/17--0.04mg, 8/20--0.03mg, 8/28--0.02mg, 9/6--0.0205mg, 9/8--0.02mg, 9/17--0.015mg, 9/20--0.01mg, 9/21--0.0048mg, 9/22--0.0001mg,

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  • 3 weeks later...

You need to let your nervous system stabilize after reinstating. How long this might take depends on how long you've been off the drug and other factors. If you were off only a couple of days, you might stabilize for a month before trying to taper. If you've been off longer, to be safe, you should give your nervous system longer to stabilize, even if symptoms go away right away. If you've been off months, it might take months before you stabilize. Do not attempt to taper again until you feel symptom-free. (Cold turkey off another psych drug simultaneously compounds the situation.)

Hello Alto,

 

Thank you so very much for creating this site.  BTW, I actually grew up in SF and went to Woodrow Wilson High on Mansell, but I think it's closed now.

 

This statement above is such a great and very important piece of information. 

 

I was wondering if you think this post or something paraphrasing it may be appropriate to add to the first page of the Forum on tapering, where reinstatement is discussed in some detail.

 

I personally was pretty frantic when I first got to SA and didn't know my way around and has so much vital information, so I initially just read the Forums and did not see the post above until a few weeks ago.

 

Just my 2 cents,

You all are the best,

 

Most Respectfully and most Sincerely,

Woof

If on a Benzo for a relatively short period of time, such as less than 6-12 months, one may want to consider tapering off their Benzo first (please see Will Hall's book on Harm Reduction)

 

Prior to commencing with an AD taper please consider what problems the AD is causing, as tapering is an extremely serious endeavor.   

If one has been on an AD for more than 10 yrs. please consider the potential long term negative consequences of AD withdrawal prior to tapering. (please see Drs. Healy, Glenmullen and Shipko) 

Prior to re-starting an AD taper, please do not resume tapering until all w/d sx's from any prior taper, especially CT, have resolved. 

 

2004 - Dec. 2015,  Cymbalta 20mg/d  for neck pain - Never had problems with Cymbalta.   Dec 2015, CT 20mg/d Cymbalta.  5 weeks later reinstated 20mg/d Cymbalta - without increase in CT sx's.   

Feb 2016 STARTED VALIUM 25mg/d for CT Cymbalta wd sxs.    Jan-April 2016 Held Cymbalta 20mg/d - doing pretty well (AM 3/10 anxiety and 3/10 tinnitus)

April 2016, CT Cymbalta sx's had not yet resolved and I prematurely tapered 10% q 4 wks x 3 mos.  After 3rd cut developed 10/10 wd sx's of Anxiety, Anhedonia, Anorexia, Panic attacks, dark, incresaed Valium to 28mg/d. 

November 2016, after 3 cuts, UP-DOSED all (41 beads) back up to 20mg (193 beads total) Cymbalta - from , dark to light.

VALIUM TAPER: Jan 2017 28mg to March 2019 Zero   Cymbalta has partially stabilized and helped with the Valium taper.  The only sx I have now is 3/10 Tinnitus, which I only notice when it is quiet.

http://survivingantidepressants.org/index.php?/topic/11900-woof-cymbalta-re-stabilization-after-cold-turkey-withdrawal/  Benzo Posts http://survivingantidepressants.org/index.php?/topic/11951-woof-valium-scheduling-and-dosage-with-cymbalta-wd-symptoms/

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  • 2 months later...

You need to let your nervous system stabilize after reinstating. How long this might take depends on how long you've been off the drug and other factors. If you were off only a couple of days, you might stabilize for a month before trying to taper. If you've been off longer, to be safe, you should give your nervous system longer to stabilize, even if symptoms go away right away. If you've been off months, it might take months before you stabilize. Do not attempt to taper again until you feel symptom-free. (Cold turkey off another psych drug simultaneously compounds the situation.)

If one did not have problems with the AD in the first place.  Tapering off them may not be the best choice for that person.  My situation is admittedly a bit odd in that I just wanted off of all meds, because I thought it was a good thing.

 

Please see my intro below.  Hopefully this can be of some help to someone in a situation like myself. 

 

For over 10 years I never experienced any problems with 20mg/d Cymbalta, It actually helped my sleep.  I wish I never started it for my neck pain, but that is way in the past.  I arrogantly just wanted to get off of all meds.

 

It's been 4 weeks now since I fully updosed to 20mg/d Cymbalta, after 3, 10% cuts.  The first cut was good as my AM anxiety immediately went away, so I thought that tapering was right for me.

 

Now I believe Alto's words above are extremely wise and that the anxiety and insomnia would have resolved, given a few more months at my reinstated dose of 20mg/d; as is empirically evidenced by my current state.

 

I was so scared to updose by 41 beads, but I did have confidence in the 4 doctors I consulted with and they all independently concurred with the action I should take - take the full 20mg pill.

 

One of these MDs is one of the 3 most cited MD's on this site, as well as within the healthcare community. 

 

While 41 beads sounds like a lot, if you look at the exponential activity curve (which these MDs were all well aware of) in combination with my dose and the fact that I had had no problems with Cymbalta in the first place,  I took their advice.

 

With the exception of my 1-3/10 tinnitus all of my sxs have resolved at this point. 

 

All of my sx's just got better and better after I updosed to my original 20mg/d level.

 

After a full year my sleep finally has come back, anxiety is gone, appetite is great, BM's are normal, I can watch sports or anything I want on TV again and Anhedonia is gone :)

 

Unfortunately, now I have to taper off of 25mg/d of Valium which I was maintaining as I was tapering, but at least my mind seems quite a bit more stabilized.

 

I will be tapering slowly off of the Valium after about another month or so of stabilization.

 

Everyone on this site has been wonderful to me and I have learned so very much from all of you, this is without question the best online site. 

 

I just hope that this post may help others. 

 

Warmest Regards,

Woof :)  

If on a Benzo for a relatively short period of time, such as less than 6-12 months, one may want to consider tapering off their Benzo first (please see Will Hall's book on Harm Reduction)

 

Prior to commencing with an AD taper please consider what problems the AD is causing, as tapering is an extremely serious endeavor.   

If one has been on an AD for more than 10 yrs. please consider the potential long term negative consequences of AD withdrawal prior to tapering. (please see Drs. Healy, Glenmullen and Shipko) 

Prior to re-starting an AD taper, please do not resume tapering until all w/d sx's from any prior taper, especially CT, have resolved. 

 

2004 - Dec. 2015,  Cymbalta 20mg/d  for neck pain - Never had problems with Cymbalta.   Dec 2015, CT 20mg/d Cymbalta.  5 weeks later reinstated 20mg/d Cymbalta - without increase in CT sx's.   

Feb 2016 STARTED VALIUM 25mg/d for CT Cymbalta wd sxs.    Jan-April 2016 Held Cymbalta 20mg/d - doing pretty well (AM 3/10 anxiety and 3/10 tinnitus)

April 2016, CT Cymbalta sx's had not yet resolved and I prematurely tapered 10% q 4 wks x 3 mos.  After 3rd cut developed 10/10 wd sx's of Anxiety, Anhedonia, Anorexia, Panic attacks, dark, incresaed Valium to 28mg/d. 

November 2016, after 3 cuts, UP-DOSED all (41 beads) back up to 20mg (193 beads total) Cymbalta - from , dark to light.

VALIUM TAPER: Jan 2017 28mg to March 2019 Zero   Cymbalta has partially stabilized and helped with the Valium taper.  The only sx I have now is 3/10 Tinnitus, which I only notice when it is quiet.

http://survivingantidepressants.org/index.php?/topic/11900-woof-cymbalta-re-stabilization-after-cold-turkey-withdrawal/  Benzo Posts http://survivingantidepressants.org/index.php?/topic/11951-woof-valium-scheduling-and-dosage-with-cymbalta-wd-symptoms/

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  • 5 months later...

Hi is there anyone out there that got relief from horrendous anxiety/panic attacks , depression by up dosing after 2 years of halving a dose, I'm on 37.5 venlafaxine and it's pretty bad ,I'm extremely desperate .

I have to say this but ide triple by dose just for relief ,I can't function at all

Respect PB

Alcohol free since February 2015 

1MG diazepam

4.5MG PROZAC.

 

 

 

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  • ChessieCat changed the title to After reinstating or updosing, how long to stabilize?

Is there a consensus on the time limititations on reinstatement or updosing after destabilization; per others who are also knowledgeable on these issues (eg Dr. Healy)?

If on a Benzo for a relatively short period of time, such as less than 6-12 months, one may want to consider tapering off their Benzo first (please see Will Hall's book on Harm Reduction)

 

Prior to commencing with an AD taper please consider what problems the AD is causing, as tapering is an extremely serious endeavor.   

If one has been on an AD for more than 10 yrs. please consider the potential long term negative consequences of AD withdrawal prior to tapering. (please see Drs. Healy, Glenmullen and Shipko) 

Prior to re-starting an AD taper, please do not resume tapering until all w/d sx's from any prior taper, especially CT, have resolved. 

 

2004 - Dec. 2015,  Cymbalta 20mg/d  for neck pain - Never had problems with Cymbalta.   Dec 2015, CT 20mg/d Cymbalta.  5 weeks later reinstated 20mg/d Cymbalta - without increase in CT sx's.   

Feb 2016 STARTED VALIUM 25mg/d for CT Cymbalta wd sxs.    Jan-April 2016 Held Cymbalta 20mg/d - doing pretty well (AM 3/10 anxiety and 3/10 tinnitus)

April 2016, CT Cymbalta sx's had not yet resolved and I prematurely tapered 10% q 4 wks x 3 mos.  After 3rd cut developed 10/10 wd sx's of Anxiety, Anhedonia, Anorexia, Panic attacks, dark, incresaed Valium to 28mg/d. 

November 2016, after 3 cuts, UP-DOSED all (41 beads) back up to 20mg (193 beads total) Cymbalta - from , dark to light.

VALIUM TAPER: Jan 2017 28mg to March 2019 Zero   Cymbalta has partially stabilized and helped with the Valium taper.  The only sx I have now is 3/10 Tinnitus, which I only notice when it is quiet.

http://survivingantidepressants.org/index.php?/topic/11900-woof-cymbalta-re-stabilization-after-cold-turkey-withdrawal/  Benzo Posts http://survivingantidepressants.org/index.php?/topic/11951-woof-valium-scheduling-and-dosage-with-cymbalta-wd-symptoms/

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14 hours ago, woof said:

Is there a consensus on the time limititations on reinstatement or updosing after destabilization; per others who are also knowledgeable on these issues (eg Dr. Healy)?

Hi Woof, I do not know you'd have to Google your above question and I don't know which Doctor Healy your referring too sorry. All I do know is no one really knows even the drug companies that manufacture these chemicals don't know how these drugs really work its all very sketchy, but personally I would rather take the word of people that have actually been through this experience their than some Doctors 'theory' that's never taken any of these drugs.

 

It was Doctors ''theories'' misdiagnosis from the very beginning before any drugs, then beyond that ruing my life for the last 36 year's . Take Benzos for instance they were actually looking for a new antibiotic but found the side effects, sedation, and many other side effects then packaged Benzos as a cure all for sleep, anxiety, stress, grief, fits etc. But the same drug can actually cause all the stuff its prescribed for and are also now listed as side effects and withdrwal effects on the new ''Patient leaflet' that's suddenly turned up in my latest batch of Diazepam  it look as if the drug companies are trying to cover their arse by now producing a ''warning'' about a LOT more ''side effects and withdrawal symptoms than they have for many year's previously

36 yrs on  BENZOS + poly drugs I was not aware  that all the ''illnesses'' I was getting misdiagnosed with  was withdrawal. I ended up ploy drugged for this reason Various Opiates, Olanzapine, amitriptyline, cipramil, trazadone tramadol   Librium Oxazepam Ativan Clomazepine Temazepam  40mg at night zimovane nitrazepam Diazepam. CT,d or rapid tapered most of  the above by force  was on 20mg of Diaz CT 10mg by force to 10mg

 

Have been trying ot get off   trying to get off the last of the  Diazepam   which I've been on for approx about 18 years since October 2014 where I'd cut to 6+1/2mg , after being steered to the Ashton manual  told that was the ''correct way to taper' not the way I had been doing all along. I got scared by the 'You have to be to heal'' mantra that goes around, but now know, too late for me unfortunately, its not true.

 

 

 

And unfortunately it was too fast a cutting rate with way too short holds and messed me up even worse. I went from  stable with the occasional very easily managed blip  to totally destabilised and disabled and house bound rapidly.

 

And horrible crippling symptoms I never had before, and my ears got hit badly along with crippling pain I have severe hyperacusis and tenacious tinnitus along with ear pain and other ear problems, and my mental realm got seriously smashed to bits too.I up-dosed by 1+1/2mg the first time November  2016 back to 5mg, as I've been stuck at 3+1/2 mg unable to barely taper for 18 months while holding for weeks, then 6 months but was still unstable.

 

Then held the 5mg for nearly 4 months but still no improvement so up-dosed by another 1/2mg February 22nd 2017 putting me at 5.1/2mg  and held  just over 10 weeks 4  days  up till now .8/5/17 Its the only drug I take now, I don't and can't  take no supplements/painkillers  or any thing else as I'm too sensitive due to withdrawal.

 

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  • 5 months later...

A lot of the problem of withdrawal and reinstatement is not knowing what's causing what. 

Now I've reinstated Sertraline after 7 months without taking it. It seems that reinstatement doesn't simply alleviate the withdrawal, but that there are onset effects of the medication (as in the first time taking it) that settle down after some time interval. 

The issue is that it's very hard to work out if symptoms are from withdrawal, or reinstatement or even underlying anxiety. And further, it's hard to work out whether a period of destabilisation is a necessary evil to get used to the reinstatement dose, or if the instability is evidence of dosing too high. 

I know that initially SSRIs build up in your blood stream, then later, neurological changes in brain function/metabolism start happening. It seems rational that this all takes time, weeks perhaps. But with ongoing effects, I find myself not knowing whether to hold steady, go down, or go up.

I'm wondering, is there an approximate amount of time that experience here has learned to wait before assessing the effects of a new dosage level?

Would be great if any mods could comment too. 

  • 2008: Started Citalopram 30mg
  • Sept 2014: Tapered down Citalopram over 6 months and discontinued Feb 2015
  • Severe withdrawals peaked in July/Aug 2015. Totally housebound.
  • Sept 2015: Sertraline started @ 100mg on GP advice.
  • Oct to Dec 2015: Reduced to Sertraline 50mg due to side effects. 
  • Jan 2016 to March 2017: Tapered Sertraline to 2mg @ 10% per month. 
  • Severe withdrawals peaked again June 2017. Totally housebound. 
  • Diazepam: July 2017 5mg // Aug 2017 2.5mg // Sept 2017 1mg // 12th Dec 2017 0.85mg 
  • Sertraline Reinstatement: 23 Oct 2017 5mg // 15 Nov 2017 10mg // 23 Nov 2017 15mg 
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Downbutnotout

I have a question. Is it everyone’s belief that antidepressants don’t help mood? I was on Effexor for many years. I was only onnotizac for 10 days. I just started prozac again st less than O.5 mg. If I take this for awhile snd then taper my mood will improve? How can my mood improve without the antidepressants. Will I end up experiencing emotion again? Be s whole person again? My current depression has robbed me of my humanity. Emotions. I feel like I had s lobotomy. 

 

2001 Remeron , Celexa, prozac a week on lithium. 

2014 went off effexor and trazadone in 3 weeks. 

2014 zoloft (hyper reaction) put on effexor 75 mg. Was stable until 2017 

2017  Trazadone 50 mg (June) Effexor to 113 mg (2 weeks) Effexor 150 mg for a month . Took 75 mg until November. . Lithium 10 days, Lamactil 10 day  aug-nov15 ativan

October : Prozac bridge to get off 75 mg of effexor Used 10 mg of prozac. Stopped prozac 3 wk 

Dec 6, 7 Upped trazadone from 50 to 100 mg Did it for 3 days Stopped it

Dec 7 , Dec 8 Took prozac again 0.1 , 0.1, 0.6 stopped it

Dec 11 and Dec 12 upped it to 100 again

Dec 15 , 16,17 went back to 50 mg of trazadone

December 18 Began 3 beads of effexor  Dec 25 began 5 beads of effexor take 10 mg of omneprazole daily

 

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I posted a question here: 

 

But I realised it probably belongs in this thread: 
 

A lot of the problem of withdrawal and reinstatement is not knowing what's causing what. 

Now I've reinstated Sertraline after 7 months without taking it. It seems that reinstatement doesn't simply alleviate the withdrawal, but that there are onset effects of the medication (as in the first time taking it) that settle down after some time interval. 

The issue is that it's very hard to work out if symptoms are from withdrawal, or reinstatement or even underlying anxiety. And further, it's hard to work out whether a period of destabilisation is a necessary evil to get used to the reinstatement dose, or if the instability is evidence of dosing too high. 

I know that initially SSRIs build up in your blood stream, then later, neurological changes in brain function/metabolism start happening. It seems rational that this all takes time, weeks perhaps. But with ongoing effects, I find myself not knowing whether to hold steady, go down, or go up.

I'm wondering, are there any guidelines for an approximate time to wait before assessing the effects of a new dosage level?

Would be great if any mods could comment too. 

  • 2008: Started Citalopram 30mg
  • Sept 2014: Tapered down Citalopram over 6 months and discontinued Feb 2015
  • Severe withdrawals peaked in July/Aug 2015. Totally housebound.
  • Sept 2015: Sertraline started @ 100mg on GP advice.
  • Oct to Dec 2015: Reduced to Sertraline 50mg due to side effects. 
  • Jan 2016 to March 2017: Tapered Sertraline to 2mg @ 10% per month. 
  • Severe withdrawals peaked again June 2017. Totally housebound. 
  • Diazepam: July 2017 5mg // Aug 2017 2.5mg // Sept 2017 1mg // 12th Dec 2017 0.85mg 
  • Sertraline Reinstatement: 23 Oct 2017 5mg // 15 Nov 2017 10mg // 23 Nov 2017 15mg 
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  • Moderator

JamesF,

 

You may already be familiar with these links:

 

After Reinstating or Updosing, How Long To Stabilize?

Stabilizing after a reduction -- what does that mean?

 

In one of the posts on reinstating, Alto said if you've been off for several months, it could take several months to stabilize.  It took me around four months to stabilize after an updose of Imipramine after about six weeks at a lower dose.  As with so much of WD, it's all individual.  

 

Here is Brassmonkey's definition of stabilization: "Stability is not the absence of WD symptoms, but rather a steady state of feeling crappy without any major swings either direction."

 

I know your question is not so much about stabilizing as ascertaining what's causing what.  Unfortunately, sometimes that just can't be figured out.

 

 

Gridley Introduction

 

Lexapro 20 mg since 2004.  Begin Brassmonkey Slide Taper Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Oct. 30, 2020  Jump to zero from 0.025mg.  Current dose: 0.000mg

3 year, 10 month taper is 100% complete.

 

Ativan 1 mg 1986-1991 CT, soon reinstated.  CT 2000. RI 1 mg 2011-2016.  Sept. 2016  0.625mg X 3

Nov.27, 2020, 7-week Ativan-Valium crossover + change to one 18.75mg dose, w/1 month hold.

Feb. 9, 2021, begin 10% every 4 weeks taper.  Current dose as of April 10: 13mgai.  Taper is 31% complete.

 

Imipramine 75 mg daily since 1986.  Jan. 2016 began every 3-weeks 10% taper, down to 16mgai (44mgpw).  Aug 2016, discovered SA, holding at 16mg.  Taper is 78% complete.  

  

Supplements: omega, vitamins C, E and D3, magnesium glycinate, probiotic, zinc, melatonin .3mg.


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

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  • Administrator

You will stabilize when you stabilize. It will take at least a few months. Please let us know how you're doing in your Introductions topic.

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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On 12/7/2017 at 8:30 AM, Downbutnotout said:

I have a question. Is it everyone’s belief that antidepressants don’t help mood? I was on Effexor for many years. I was only onnotizac for 10 days. I just started prozac again st less than O.5 mg. If I take this for awhile snd then taper my mood will improve? How can my mood improve without the antidepressants. Will I end up experiencing emotion again? Be s whole person again? My current depression has robbed me of my humanity. Emotions. I feel like I had s lobotomy. 

 

Antidepressants can improve mood, but long term use comes at a cost (many risks with long term use, including physical dependence and possibly increased vulnerability to depression). They often suppress healthy and good emotion along with "bad" (unpleasant) emotion, leaving you numb or apathetic or both. In some people they worsen depression from the start (an adverse reaction).

 

If you take Prozac for a while at 0.5mg, will your mood improve? It depends. Do you have depression or are you in withdrawal? At 0.5mg, Prozac will do nothing for depression, but might help withdrawal depression, depending on how long you've been in withdrawal and how your body responds to different medications.

 

What you're calling depression (the "lobotomy") sounds like the side effects of long term antidepressant use I described in the first paragraph. Unless this started after a major stressor in your life, it's likely drug-induced. If thats the case, adding more antidepressants will only make it worse. Check the topic on Anhedonia in this forum to understand better. You need to be abstinent of all psych meds for a few years and work with a therapist to help your brain heal. 

 

Anhedonia is my worst symptom, so I can relate. It's taking years to heal and I'm still tapering excruciatingly slow (both Proza and Effexor). Therapy is helping me with skills to rewire my brain faster, but it still takes a long time.

 

I wish you well. PM me if you want to chat :)

 

 

  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivingantidepressants.org/index.php?/topic/6012-newbeginning-my-withdrawal-story/?p=267313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression; tried updosing to 17 beads Feb 7 but anxiety got worse; went down to 16 beads

    May 2017: Anxiety improved; severe depression continues

  • September 2017: finally stabilized!!!!!! 09/07/2017-12/31/2017: hold

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On 12/7/2017 at 9:15 AM, JamesF said:

I posted a question here: 

 

 

 

Hi JamesF,

 

You ask very good questions, but I'm afraid it's impossible to know. If you feel worse after reinstating, perhaps you reinstated too high a dose? It's always best to start super low and increase gradually, if lower dose doesn't work. After 7 months being off, it's very hard to predict how much you will stabilize and how fast. It took me 9 months to stabilize after a 7% cut.  It depends on how unstable you were and on your body. Stress can also prolong the time it takes to stabilize too, in my experience-so try to decrease your stressors as much as you can.

 

If you feel worse than you did before reinstating, I personally would cut the dose. Once you find a dose that is not making you worse, you can stay there or increase much more gradually, keeping in mind it can take many months to stabilize. It can take many months or longer to stabilize from protracted withdrawal with no reinstatement as well. So you're basically waiting for your brain to heal, hoping to shorten the time with reinstatement, but not knowing how long it will take or how effective it will be.  

 

I sure hope you stabilize soon!

  • SSRIs 3-4 times in the last 14 years; would take them for 6-8 months and then taper off under dr supervision with no problems.
  • Med history prior to 2015: http://survivingantidepressants.org/index.php?/topic/6012-newbeginning-my-withdrawal-story/?p=267313#entry267313
  • 04/2015: Prozac decreased to 15mg over last 3 months; effexor held steady at 8mg; current effexor XR: 20 beads of a 75mg capsule per day (about 8mg)
  • 06/2015: Prozac: 10mg; effexor XR: 19 beads (about 7.5mg); 07/2015: Prozac: 8.5mg; effexor 18 beads; 08/2015: Prozac: 7.5mg; effexor: 17 beads
  • End of August: withdrawal: depressive symptoms, crying spells. Realized I was measuring prozac dose wrong for the last 2 months. Reinstated Prozac 8.5mg; Kept effexor at 17 beads. Stabilized in 5 weeks.
  • 10/2015: Prozac: 8.5mg; effexor: 17 beads
  • 11/2015: Prozac: 1.9ml (7.5mg); effexor: 16 beads
  • 12/2015: Prozac: 1.6ml; effexor xr: 16 beads. Withdrawal: neuroemotions
  • 01/2016: prozac: 1.6ml; effexor xr: reinstated 17 beads, withdrawal improved; 02/2016: Prozac 1.5ml; Effexor: 17 beads; 03/2016: Prozac 1.3ml(5mg); Effexor: 17 beads (7mg)-withdrawal (flu-like malaise, lightheaded, drowsy) started end of March. April 15: reinstated Prozac 1.5ml. Stabilized. 2 weeks ok. End of April: Withdrawal (neuroemotions). Eventually stabilized in April-May. Apathy improved.
  • 3 month hold until August. August 2016: apathy came back;

  • October 2016: updosed to Prozac 1.6ml. Bad reaction: anxiety, depression. End of October: went down Prozac 1.5ml. Stabilized over several weeks.

  • Dec 9: tried macca for energy: anxiety/depression. Improved over several weeks, but not completely resolved.

  • Dec 31: cut Effexor 5% to 16 beads. After 9 days: withdrawal anxiety, depression; tried updosing to 17 beads Feb 7 but anxiety got worse; went down to 16 beads

    May 2017: Anxiety improved; severe depression continues

  • September 2017: finally stabilized!!!!!! 09/07/2017-12/31/2017: hold

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  • 6 months later...

Hi Mama flower  I am in the same boat as you after reinstating 2.5mg then up to 5 mg of Paxil 3 months ago.  But I feel worse than ever, and am finding it very hard to get out of bed or think straight at all.  I have tried decreasing slightly but the electric shocks are unbearable.  I think my CNS is totally unstable.  How do you cope on s daily basis?    Best wishes.    Nada

On Paxil 10mg  2008-2015

Withdrew Paxil Sept 2015 - Dec 2016

Reinstated 1mg Paxil end Jan. 2017

Updosed  to 2.5mg Paxil June 2017

Reinstatement not working

Benadryl 25mg some nights 

 

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  • 3 months later...

Effexor XR.  When does one start to feel better after a taper crash and updose/reinstatement?

 

These are thoughts from my own records and experience.  Maybe they will prove helpful to someone, but caution advised, as we all know "everyone is different."

 

I commenced the "SA" taper 2 years ago from 225.0mg.

Today, after my crash at about 56mg, 6 months ago,  I am in the 5th day of feeling much better.  A good "window".

When I realised I had well and truly crashed and burned, I made four modest updoses over the last four months to where I am now.

to 62.5mg (hold 33 days)

to 75.0mg (32 days)

to 87.5mg (25 days) - suffering badly, but possibly, if I had stuck it out for another week, may have been sufficiently stabilised.)

to 100.0mg with current window commencing after 22 days.

 

My journal/spreadsheet also reports of a reinstatement after a crash at 0.0mg* 12 years ago in spring 2006 - "75mg - getting better, 21days....."

*Effexor XR again.

 

Our NHS is more cautious - 

"Depressed mood and lack of interest in activities may need up to 6-8 weeks to fully improve."

But this refers to ADs in general, not Effexor/venlafaxine specifically.

 

The AD experiences of reinstating/updosing/tapering/crashing/staying off can be overwhelming and seemingly endless.  Patience can pay off, though, if we are fortunate.

 

 

Born 1945. 

1999 - First Effexor/Venlafaxine

2016 Withdrawal research. Effexor.  13Jul - 212.5mg;  6Aug - 200.0mg;  24Aug - 187.5mg;  13Sep - 175.0mg;  3Oct - 162.5mg;  26Oct - 150mg 

2017  9Jan - 150.00mg;  23Mar - 137.50mg;  24Apr - 125.00mg;  31May - 112.50mg holding;  3Sep - 100.00mg;  20Sep - 93.75mg;  20Oct - 87.5mg;  12Nov - 81.25mg;  13 Dec - 75.00mg

2018  18Jan - 69.1mg; 16Feb - 62.5mg; 16March - 57.5mg (-8%); 22Apr - 56.3mg(-2%); CRASHED - Updose 29May - 62.5mg; Updose - 1Jul - 75.0mg. Updose - 2Aug - 87.5mg. Updose - 27Aug - 100.0mg. Updose - 11Oct 112.5mg. Updose - 6Nov 125.00mg

2019 Updoses 19 Jan - 150.0mg. 1April - 162.5mg. 24 April - Feeling better - doing tasks, getting outside.  7 May - usual depression questionnaire gives "probably no depression" result.

Supps/Vits  Omega 3;  Chelated Magnesium;  Prebiotics/Probiotics, Vit D3. 

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  • 3 weeks later...
On 3/14/2013 at 2:06 AM, tezza said:

 

I was one sick puppy for all those months but when I started getting better it gradually got progressively better from then on. I still feel some fleeting moments, almost like flashbacks, of mild depression. The anxiety has improved tremendously. Sleep isn't perfect but usually tolerable. Muscle twitches are only occasional now. Tinnitus is 90% better.

This gives me so much hope.

1999:  Paroxetine (20mg). Age 16. 2007-2008: Fluoxetine (Prozac) for 1.5 years (age 25) Citalopram 20mg 2002-2005, 2009: Escitalopram (20mg), 2 weeks, (age 26) (adverse manic reaction)/*Valium 5mg/Temazepam 10mg 2010: Mirtazipine (Remeron)( do not remember dosage) 2010, 5 months.                     

2010-2017: Citalopram (20mg) (age 27 to 34) 2016: i.1st Sept- 31st Oct Citalopram 10mg , ii.1st November 2017-30th November 2017, Citalopram 5mg iii.1st December 2017- 4th February 2018, Citalopram 0mg, iv.5th February 2018- March 2018 Citalopram 5mg (10mg every other day) 28th February- tried titration of 5mg ( some adverse effects)

2018: 1st March 2018- 1st June Citalopram 10 mg (tablet form) /started titration 8mg , then 7 mg.2018: June 15th- 10th July Citalopram 10 mg pill every other day 2018: 10th July - 13th Sept Citalopram- 0mg  (CBD oil first month of 0mg, passiflora on and off) 2018 13th Sept Citalopram  2mg ,  approx 16th Sept 4mg , approx 25th Sept 6mg held.  2019: 11 Feb 19: 7mg (instant bad rxn) 12 Feb 19 6mg held 1 May 19 5.4mg held 5 Oct 19 5.36mg 22 Oct 19 5.29mg 30 Oct 19 5.23mg 4/NOV/19 5.18mg 12 Nov 19 5.08mg 20 Nov 19 4.77mg

(Herbal/Supplements since 1st September: Omega Fish Oil 1200mg, 663mg of EPA- 2 tablets a day, magnesium and magnesium bath salts)

I did not die, and yet I lost life’s breath
- Dante
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  • 1 year later...

Hey guys,

 

I’ve been holding at 10mg of Lexapro for 6 weeks and have had some noticeable improvements and actually felt moments of mild happiness at certain points for sure however I feel like my energy and motivation has started to decrease as opposed to increase. My main discomfort is physical pain and contorted/stiff muscles and insides which has definitely improved but is still there. 
 

I’m wondering if I am going through a wave or if maybe I should decrease by a 10 percent and see if that makes a difference? Maybe I am stabilising but it’s now a bit more than what’s needed for my body? Or should I hold at 10 till I reach around the 12 week mark at this dose? I don’t feel as though I should increase but that’s also an option I guess.. 

 

Any insight would be helpful. It could just be a bad lengthy wave.

 

Thank you! 

-Zoloft for 2-3 months (late 2010)

-Fast tapered and started citalopram for 2-3 months ( Early 2011)

-Fast tapered and started on lexapro at 10 mg, worked up to 20-25mg (Mid 2011)

-Stayed on Lexapro for a couple of years (2011 to early/mid 2013)

-Stopped for a bit, not sure how long I can't remember. 
-Started lexapro again around 2014, worked up to around 20mg I think. Somewhere in that year tried luvox, bad experience went back to Lexapro.
-Tapered off Lexapro again around mid 2015 maybe? Stayed off until the Beginning of 2018.
-Started back at 10mg, stayed there till the end of 2018. Fast tapered at the beginning of 2019. 
-More severe withdrawal symptoms started, reinstated after a couple of months at 10mg, went up to 20 briefly, back to 10mg until the end of 2019. 

-Since been off Meds from the start of December 2019 to now. 

 

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It can take a few months rather than weeks before you get stable if you read right  through this whole  thread, if It were me I would hold for 12 weeks then  reassess  my situation as to whether continue holding until I stabilised more or trying a very small cut . Also if you think you may be in a wave then holding is definitely your best option I believe rather than put any more stress on your CNS by cutting for now .

 

 

All the best Zzann x

36 yrs on  BENZOS + poly drugs I was not aware  that all the ''illnesses'' I was getting misdiagnosed with  was withdrawal. I ended up ploy drugged for this reason Various Opiates, Olanzapine, amitriptyline, cipramil, trazadone tramadol   Librium Oxazepam Ativan Clomazepine Temazepam  40mg at night zimovane nitrazepam Diazepam. CT,d or rapid tapered most of  the above by force  was on 20mg of Diaz CT 10mg by force to 10mg

 

Have been trying ot get off   trying to get off the last of the  Diazepam   which I've been on for approx about 18 years since October 2014 where I'd cut to 6+1/2mg , after being steered to the Ashton manual  told that was the ''correct way to taper' not the way I had been doing all along. I got scared by the 'You have to be to heal'' mantra that goes around, but now know, too late for me unfortunately, its not true.

 

 

 

And unfortunately it was too fast a cutting rate with way too short holds and messed me up even worse. I went from  stable with the occasional very easily managed blip  to totally destabilised and disabled and house bound rapidly.

 

And horrible crippling symptoms I never had before, and my ears got hit badly along with crippling pain I have severe hyperacusis and tenacious tinnitus along with ear pain and other ear problems, and my mental realm got seriously smashed to bits too.I up-dosed by 1+1/2mg the first time November  2016 back to 5mg, as I've been stuck at 3+1/2 mg unable to barely taper for 18 months while holding for weeks, then 6 months but was still unstable.

 

Then held the 5mg for nearly 4 months but still no improvement so up-dosed by another 1/2mg February 22nd 2017 putting me at 5.1/2mg  and held  just over 10 weeks 4  days  up till now .8/5/17 Its the only drug I take now, I don't and can't  take no supplements/painkillers  or any thing else as I'm too sensitive due to withdrawal.

 

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  • 10 months later...
HardTimes

I'm really trying to sort out reinstatement, and have just read this whole thread. For anyone else looking into it and go to the more recent first, here are some really short summary points from this thread:

  • How long does it take to stabilize after a reinstatement? It all depends, there isn't an easy answer. However, some in this thread report "many months", so don't panic if you're not feeling better after a week or two.
  • There was also a lot about when to eventually taper after reinstatement. Consensus seems to be not to taper until symptoms are pretty much gone, or at least quite tolerable. However, BrassMonkey points out (helpfully, I think) that "stable" doesn't necessarily mean "no symptoms". It means less swinging back and forth. (See Oct. 17 2015 ff)
  • Consensus view (from main reinstatement thread) is that reinstatement, particularly after a long time at zero, can be a "crap shoot", with results pretty difficult to predict. At the same time, from my reading, it looks as though loads of people (the majority?) seem to have not too much difficulty reinstating, and are mostly concerned with tapering after a successful reinstatement. 
  • However the thread lacks specific information of examples of what reinstatement actually looks like. As in, were successful people just jumping back on to their last prescribed dose? Or did they have to slowly updose to reach stability? If so, how quickly? The closest question here comes from @JamesF on Dec 7, 2017. He seems to share my current struggle of reinstating at a very low dose and then becoming muddled about whether ongoing or different symptoms are caused by the reinstatement (meaning reduce) or just not giving it long enough to stabilize (meaning hold) or not taking a big enough dose (meaning increase). Unfortunately there is no easy answer to his/my question, other than careful symptom tracking and listening to your body.

For what its worth, I'm in James's situation. Three months trying to reinstate, started at tiny dose (0.25mg Citalopram), updosing gradually to 0.75, which is still way, way below the 5mg I was at when I stopped. I tried updosing further a week ago with a bad result, leading to my current investigations. Having looked carefully at my journaling, I think I'm seeing that in fact NEW, unpleasant symptoms emerged when I reinstated (nervousness, a sense of tingling, boiling blood, etc.), and have not calmed down over these months (though I did have a nice long window just before trying last updose, and thought I had stabilized, so...???). I also notice that I get a wave of symptoms roughly 2-3 hours after taking the dose, even when I change the time of day when I take it. This further suggests the symptoms are connected to the drug reinstatement, not just regular W/D. So I'm thinking maybe my reinstatement has failed and should be reduced/tapered/quit. 

 

Might be good to hear from James or anybody else who can report with some details on successfully navigating the uncertainty of reinstatement?

 

Also, if you are looking for a long read, @Odwina's story might be of help too... Sounds familiar so far. 

 

15+ years Citalopram 10mg (sometimes 20?)

2019 Citalopram 5mg. No problem reduction.

2020 Citalopram 5mg to zero. (Feb)

2020 (Feb - mid Oct): Very rare use of 0.125 or .25mg Xanax for really bad symptoms

2020 (Feb - Nov): Occasional use of "Nytol" sleep aid (an antihistamine). 

2020 Failed reinstatement: Escitalopram by accident (not Citalopram).  

 -- using a scale, started July 27 0.5mg, doubled every week or so to reach 5mg by Aug 30. Too fast - terrible depression, quit.

2020 (Oct-current): Supplements:

 -- Morning: Magnesium 300mg, Omega 3(483 EPA, 360 DHA +Vit E) Night: Liquid Valerian/Passiflore/Escholtzia - French organic herbal sleep aid, 1.9mg LD Melatonin 

2020 Current - new Citalopram reinstatement. (Accidentally started with Escitalopram before realizing and switching to Citalopram Oct. 30)

 -- using pipette method: Oct 30, 0.25mg; Nov. 4th, 0.375; Dec. 1st 0.5mg, Dec. 21st 0.75mg Jan 19: Decide reinstatement fail: Jan 21 0.625mg, Jan 28: 0.5mg Feb 8 0mg

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HardTimes

Not sure anybody will read or see this, but I've just done an analysis of my own situation that might be helpful for others thinking about this question. Big caveat: The rule here is that everybody is different when it comes to reinstatement or updosing, and my experience may not at all be like your own (see above!). But for what it is worth, in my own situation:

  • Updosing always seemed to increase severity of symptoms or introduce unusual variations on symptoms. I suddenly had a sense of blood boiling, a certain kind of adrenaline nervousness, hot flashes, heart pounding/palpitations, feeling “drugged/stoned”, mild nausea, pressure headaches, which were all new or more intense.
  • Symptoms remained long after updosing (I don't think I've ever "stabilized" after 3 months of effort), but took about 3-5 days to diminish from the initial spike right after the updose. 
  • I seem to have chosen to updose often after a reasonably good patch (3-5 days of fairly tolerable symptoms). I think my reasoning was that the good patch indicated my body had come to tolerate the dose, and if I moved up a bit it would even further reduce symptoms. I think this was likely a mistake, as it always threw things into a tailspin. 

And for what it is worth, I think my three month attempt at reinstatement has likely been counter-productive and a failure, as suggested by these rather super-geek level statistics:

  • In the 49 days before reinstating I had:
    • 24% Red, bad days of heavy symptoms
    • 20% Yellow, so-so days of intrusive symptoms
    • 55% Green, good to symptom free days
  • In the 78 records after reinstatement, I had:
    • 24% Red or “orange” bad to pretty bad days
    • 42% Yellow, so-so days
    • 33% Green to yellow/green pretty good days. 

This indicates bad days did not diminish percentage-wise, and green days went down while yellow days went up. Even though this is really not an exact science, this suggests I was better off in the period before the reinstatement. 

 

So my advice: TRACK YOUR SYMPTOMS even (especially) when you no longer see the point. It doesn't have to be hyper complicated, just note how much you sleep and somehow quantify your symptoms (there's lots of advice on here somewhere about various tracking strategies. For me numerical values started to just seem too complicated - now a good is green, bad is red, so-so is yellow, and I can do in-betweens too, like orange or light green. 

15+ years Citalopram 10mg (sometimes 20?)

2019 Citalopram 5mg. No problem reduction.

2020 Citalopram 5mg to zero. (Feb)

2020 (Feb - mid Oct): Very rare use of 0.125 or .25mg Xanax for really bad symptoms

2020 (Feb - Nov): Occasional use of "Nytol" sleep aid (an antihistamine). 

2020 Failed reinstatement: Escitalopram by accident (not Citalopram).  

 -- using a scale, started July 27 0.5mg, doubled every week or so to reach 5mg by Aug 30. Too fast - terrible depression, quit.

2020 (Oct-current): Supplements:

 -- Morning: Magnesium 300mg, Omega 3(483 EPA, 360 DHA +Vit E) Night: Liquid Valerian/Passiflore/Escholtzia - French organic herbal sleep aid, 1.9mg LD Melatonin 

2020 Current - new Citalopram reinstatement. (Accidentally started with Escitalopram before realizing and switching to Citalopram Oct. 30)

 -- using pipette method: Oct 30, 0.25mg; Nov. 4th, 0.375; Dec. 1st 0.5mg, Dec. 21st 0.75mg Jan 19: Decide reinstatement fail: Jan 21 0.625mg, Jan 28: 0.5mg Feb 8 0mg

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I have read all the posts on this thread and am still not sure what to do. I tapered too quickly. As I tapered, my worst WD symptom, insomnia, keep getting worse and worse, but I was just determined to get off of Remeron at all costs. Got down to zero and the insomnia was so bad that I could only sleep an hour a night. For my sanity — literally — I have to either reinstate or get on another drug to help me sleep. I reinstated at .6 mg two days ago. The first night, I woke up frequently but fell right back to sleep and got decent rest. I thought I’d found my solution, but then last night insomnia was bad again. Does this argue for me to increase again tonight, maybe up to 1 mg, or to hold steady at .6 to see if things will improve?

  • 7.5 mg Remeron about a year ago (I think February 2020) 
  • Stopped CT in August 2020, I think?
  • Reinstated at about 2.5 mg in September 2020 (liquid taper)
  • Started Buspirone (5 mg 3x day) in November 2020
  • Tapered to 2 mg for October, then dropped to 1.05 for November, and then down by .15 mg once/week for December (.9 first week, .75 second week, .6 third week, .45 fourth week, .3 fifth week) so that I was at .15 mg (1 mg of liquid) at the start of January 2021
  • Stopped in second week of January 2021 and am seeking support -- experiencing extreme insomnia
  • Supplements: 200 mg magnesium, .5 mg melatonin, 2000 mg Vitamin D, Omega 3 (kelp-based)
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